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Speech Sound Disorders

Center for childhood communication, what are speech sound disorders .

As children learn to speak, they make words easier to say by deleting or changing sounds. As they grow older, children say more speech sounds. This makes their words easier to understand. If your child has a speech sound disorder, they cannot say sounds and words like other children their age.

Three types of speech sound disorders include:

• Articulation disorder: difficulty saying certain speech sounds. You may notice your child drops, adds, distorts or substitutes sounds in words.
• Phonological process disorder: where your child uses patterns of errors. The mistakes may be common in young children learning speech skills. When the errors continue past a certain age, it may be a disorder.
• Disorders that involve a combination of articulation and phonological process disorders.

Some sound changes may be part of your child’s accent or family dialect, and not a true speech disorder.

Causes of speech sound disorders

Speech sound disorders can be caused in a few ways:

• Developmental (your child was born with the disorder)
• Motor or neurological ( childhood apraxia of speech )
• Structural ( cleft lip and palate )
• Sensory or perceptual conditions (like hearing loss )

Symptoms of speech sound disorders 

Signs of a speech sound disorder can include:

• Substituting sounds in words (saying “wain” instead of “rain”)
• Distorting sounds in words (saying “thoap” instead of “soap”)
• Adding sounds to words (saying “puhlay” instead of “play”)
• Saying only one syllable in a word (saying “bay” instead of “baby”)
• Simplifying a word by repeating a syllable (saying “baba” instead of “bottle”)
• Leaving out a consonant sound (saying “at” or “ba” instead of “bat” or saying “tar” instead of “star”)
• Saying words differently each time (saying “buh” for “go” the first time, then “agah” for “go” the second time)

Testing and diagnosis for speech sound disorders

One of our speech-language pathologists (SLP) may assess your child’s speech through formal testing, language samples, play-based activities, and observations of your child’s mouth structures and movements. Our SLP will determine if your child’s sound errors are expected for their age. If not, they may have a speech sound disorder. Treatment with a CHOP SLP can help your child with their speech development.  

Treatment for speech sound disorders 

Our SLP will create goals to support your child’s speech development. Goals may include recognizing speech sounds and learning how to say speech sounds and words. Each child is unique and may have different needs. The therapy approach will depend on the specific diagnosis and your child’s needs. Once your child says a sound in therapy on their own, it will take time for them to say it consistently. Our SLP will work patiently with your child toward their speech development goals.

Speech-language therapy sessions involve you, your child, their other caregiver(s) and a SLP. Sessions may be play-based or structured with tabletop activities. This will depend on your child’s needs and abilities. Sessions also include your child's interests and your family's culture. This leads to better engagement, relevance, learning and fun.

Early recognition and diagnosis of speech sound disorders can help your child overcome speech problems. With proper treatment and support, your child can learn how to communicate clearly.

Speech Sound Disorder

Reviewed by Psychology Today Staff

Speech sound disorder (SSD) encompasses a group of communication disorders in which children have persistent difficulty articulating words or sounds correctly. Speech sound production requires both the phonological knowledge of speech sounds and the ability to coordinate the jaw, tongue, and lips with breathing and vocalizing to produce meaningful sounds. Children with speech sound disorder may have difficulty with the phonological knowledge of speech sounds or the ability to coordinate the movements necessary for speech. The communication difficulties can impede the development of children by limiting their ability to effectively participate in social, academic, or occupational activities.

While some speech sound disorders stem from physical structural anomalies, such as cleft palate, others have their origin in perceptual problems such as hearing impairment. Still others, like apraxia, in which the brain does not deliver the correct movement instructions to the target muscles, arise from neurodevelopmental problems.

Most children shorten words and syllables as they’re learning to talk, but children with speech sound disorder continue this simplification process past the age when most children can produce words clearly, generally agreed to be age 7.

The DSM-5 includes the following diagnostic criteria for speech sound disorder:

• Persistent difficulty with the production of speech sounds that interferes with the intelligibility of one's speech or prevents verbal communication
• Limitations on communication interfere with social participation or performance at school or work
• The symptoms begin early in life and are not attributable to other medical or neurological conditions

Developmental experts believe that approximately half of a child’s speech is intelligible by age 2 and most speech intelligible by age 4.

According to the Child Mind Institute, other potential signs of a speech sound disorder include:

• Leaving out sounds or substituting an incorrect sound for a correct one
• An unusually hoarse or nasal voice or sudden changes in pitch or loudness that make understanding speech more difficult
• Running out of air while talking

Stuttering is a common example of a speech sound disorder. Another particularly common example is lisping. Depending on the severity of the lisp or stutter, children may attempt to avoid words or phrases with which they struggle due to the anxiety of anticipating their dysfluency.

A speech-language pathologist tests a child's speech for how well he or she creates sounds and inspects how the child moves his or her lips, jaw, and tongue. The pathologist may also test the child’s hearing.

Speech sound disorder is not the same as a specific language impairment. Speech sound disorder expresses itself with a delayed ability to produce speech sounds, while specific language impairment expresses itself with an inability to incorporate the structures of grammar into speech. Only about 2 percent of children with speech sound disorder also have specific language impairment.

According to the National Institute on Deafness and Other Communication Disorders, the prevalence of speech sound disorder in young children is 8 to 9 percent of the population. By first grade, roughly 5 percent of children exhibit speech sound disorder.

The cause of speech sound disorder is not well understood in many cases. Children who develop speech sound disorder often have family members with a history of speech or language disorder, suggesting a genetic component of this condition. Speech sound disorder may occur along with other delays in the use of facial musculature, such as difficulties in chewing, maintaining a closed mouth, and blowing one’s nose

Hearing impairment or deafness do often result in abnormalities of speech sounds. This does not mean someone with a hearing impairment has a neurodevelopmental speech sound disorder. For instance, a child who receives cochlear implants may be able to catch up to peers in speech sound production due to their new ability to hear others better. 

Speech sound disorder is a neurodevelopmental disorder unrelated to anxiety. The disorder could, however, lead to anxiety in children who are unable to fully express themselves. Such anxiety could be expressed as selective mutism , where children do not speak in certain circumstances due to embarrassment .

There is substantial research suggesting the heritability of speech sound disorder. Studies have demonstrated familial aggregation for SSD, where approximately 26 percent of nuclear family members and 13.6 percent of extended family members were affected in a cohort of children with SSD.

Treatment for speech sound disorder primarily consists of speech and language therapy . A speech-language pathologist typically develops a treatment plan that helps a child identify and correct the specific sounds or words they have difficulty articulating. The speech-language pathologist may show the child how to move their tongue and lips to produce sounds correctly and provide opportunities to practice these skills.

In most cases, children with speech sound disorder respond well to speech therapy; speech difficulties improve over time. The condition appears to resolve in 75 percent of children by age 6. When a language disorder is also present, however, speech sound disorder has a poorer prognosis and may be associated with learning disorders.

According to the American Speech-Language-Hearing Association, treatment is generally done with the help of a speech pathologist and focusing on: establishing a target sounds to work on producing reliably, working up from syllables to words to sentences, and, finally, stabilizing this sound production to the point where the patient is able to self-monitor and self-correct.

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6.1: Definitions of Communication Disorders

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The Individuals with Disabilities Education Act (IDEA) defines a speech or language impairment as the following:

Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance (Individuals With Disabilities Education Act, Part B, Subpart A § 300.8(c)(11)(2004)).

This definition is used to determine whether a student with a communication disorder is eligible for special education and related services. However, many professionals also use the following definitions from the ASHA. ASHA provides the following more detailed definition of communication disorder.

A communication disorder is an impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be evident in the processes of hearing, language, and/or speech. A communication disorder may range in severity from mild to profound. It may be developmental or acquired. Individuals may demonstrate one or any combination of communication disorders. A communication disorder may result in a primary disability, or it may be secondary to other disabilities (ASHA, 1993).

ASHA also provides detailed definitions of the different types of communication disorders, including speech disorders, language disorders, and central auditory processing disorders.

A speech disorder is an impairment of the articulation of speech sounds, fluency and/or voice.

• An articulation disorder is the atypical production of speech sounds characterized by substitutions, omissions, additions or distortions that may interfere with intelligibility.
• A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. This may be accompanied by excessive tension, struggle behavior, and secondary mannerisms.
• A voice disorder is characterized by the abnormal production and/or absences of vocal quality, pitch, loudness, resonance, and/or duration, which is inappropriate for an individual’s age and/or sex.

A language disorder is impaired comprehension and/or use of spoken, written and/or other symbol systems. The disorder may involve (1) the form of language (phonology, morphology, syntax), (2) the content of language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination.

• Phonology is the sound system of a language and the rules that govern the sound combinations.
• Morphology is the system that governs the structure of words and the construction of word forms.
• Syntax is the system governing the order and combination of words to form sentences, and the relationships among the elements within a sentence.
• Semantics is the system that governs the meanings of words and sentences.
• Pragmatics is the system that combines the above language components in functional and socially appropriate communication.

Central auditory processing disorders (CAPD) are deficits in the information processing of audible signals not attributed to impaired peripheral hearing sensitivity or intellectual impairment. This information processing involves perceptual, cognitive, and linguistic functions that, with appropriate interaction, result in effective receptive communication of auditorily presented stimuli. Specifically, CAPD refers to limitations in the ongoing transmission, analysis, organization, transformation, elaboration, storage, retrieval, and use of information contained in audible signals. CAPD may involve the listener’s active and passive (e.g., conscious and unconscious, mediated and unmediated, controlled and automatic) ability to do the following:

• attend, discriminate, and identify acoustic signals;
• transform and continuously transmit information through both the peripheral and central nervous systems;
• filter, sort, and combine information at appropriate perceptual and conceptual levels;
• store and retrieve information efficiently; restore, organize, and use retrieved information;
• segment and decode acoustic stimuli using phonological, semantic, syntactic, and pragmatic knowledge; and
• attach meaning to a stream of acoustic signals through use of linguistic and nonlinguistic contexts (ASHA, 1993).

Finally, ASHA differentiates a communication disorder from communication variations including communication difference/dialect and augmentative/alternative communication.

Communication difference/dialect is a variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors. A regional, social, or cultural/ethnic variation of a symbol system should not be considered a disorder of speech or language.

Augmentative/alternative communication systems attempt to compensate and facilitate, temporarily or permanently, for the impairment and disability patterns of individuals with severe expressive and/ or language comprehension disorders. Augmentative/alternative communication may be required for individuals demonstrating impairments in gestural, spoken, and/or written modalities (ASHA, 1993).

APA Definition

In addition, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association includes disorders of communication which include language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), social (pragmatic) communication disorders, and unspecified communication disorders. The diagnostic criteria for each are included below.

Language Disorder

• Reduced vocabulary (word knowledge and use).
• Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
• Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).
• Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.
• Onset of symptoms is in the early developmental period.
• The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay (DSM-5-TR, 2022, p. 47).

Speech Sound Disorder

• Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication or messages.
• The disturbance causes limitation in effective communication that interferes with social participation, academic achievement, or occupational performance, individually or in any combination.
• Onset of symptoms in the early developmental period.
• The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions (DSM-5-TR, 2022, p. 50).

Childhood-Onset Fluency Disorder (Stuttering)

• Sound and syllable repetitions.
• Sound prolongations of consonants as well as vowels.
• Broken words (e.g., pauses within a word).
• Audible or silent blocking (filled or unfilled pauses in speech).
• Circumlocutions (word substitutions to avoid problematic words).
• Words produced with an excess of physical tension.
• Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”).
• The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination.
• The onset of symptoms is in the early developmental period.
• The disturbance is not attributable to a speech-motor or sensory deficit, disfluency associated with neurological insult (e.g., stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder (DSM-5-TR, 2022, p. 51-52).

Social (Pragmatic) Communication Disorder

• Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
• Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding the use of overly formal language.
• Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
• Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral and ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
• The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
• The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
• The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual developmental disorder (intellectual disability), global developmental delay, or another mental disorder (DSM-5-TR, 2022, p. 54).

The Illinois Definition of Speech or Language Impairment

Speech or Language Impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance (ISBE, 2022).

Activity \(\PageIndex{1}\): Compare and Contrast

Directions: Compare and contrast the IDEA, ASHA, APA, and Illinois definitions of communication disorders. Consider the differences and similarities between diagnostic criteria.

 Individuals With Disabilities Education Act, Part B, Subpart A § 300.8(c)(11)(2004).

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper] . https://www.asha.org/policy/rp1993-00208/

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. Text Revision). https://doi.org/10.1176/appi.books.9780890425596

Illinois State Board of Education. (2022, October 7). Special education disability areas . https://www.isbe.net/Pages/Special-Education-Disability-Areas.aspx

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Communication Disorders

• A communication disorder is a neurodevelopmental disorder characterized by impairments in sending, receiving, processing, or comprehending verbal, nonverbal, or graphic language, speech, and/or communication.
• Communication disorders may be developmental or acquired (secondary to trauma or neurological disorder).
• Language is one of five major streams of development, within which developmental milestone acquisition occurs at a specific rate in an orderly and sequential manner [1] .
• Deviation from these milestones may signal the presence of a communication disorder
• For further developmental information, please see the American Academy of Pediatrics’ Bright Futures ( http://brightfutures.aap.org/index.html ) or the CDC’s Milestones ( http://www.cdc.gov/NCBDDD/actearly/milestones/index.html )
• Communication disorders fall into a number of separate diagnoses (language disorder, speech sound disorder, childhood-onset dluency disorder, social communication disorder) and are classified under the Neurodevelopmental Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [2] .

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Speech Sound Disorders

A speech sound disorder occurs when a person has difficulty producing speech sounds, affecting his or her ability to communicate. Children often make mistakes as their vocabulary grows, but a speech sound disorder occurs past the age at which they are expected to know how to make the correct sounds. 

Types of Speech Sound Disorders

There are two main types of speech sound disorders: articulation disorders and phonological disorders. 

Articulation disorders involve problems making sounds. Sounds may be substituted, omitted, added or distorted. This results in speech that is difficult for others to understand. Common problems include substituting the letter “r” with “w” (“wabbit” for “rabbit”), shortening words or speaking with a lisp. 

Phonological disorders involve patterns of sound errors. Mistakes are made with entire groups of words; for instance, sounds made in the back of the mouth may be substituted with sounds made in the front of the mouth, e.g. substituting the letter “d” for “g” (“got” for “dot”). People with phonological disorders are often able to hear these errors when others speak, without picking up on their own mistakes.  

Causes & Treatment

Many times, the cause of speech sound disorders is unknown. Children may not learn how to correctly pronounce certain sounds, and this can carry over into adulthood. Other times, the cause is physical in nature. Developmental disorders, genetic syndromes, neurological disorders, hearing loss and other illnesses may all contribute to speech sound disorders. 

A speech-language pathologist (SLP) will thoroughly evaluate a patient to determine the cause of the disorder and recommend a course of treatment. He or she will work closely with the individual to improve communication skills. 

Speech Delay

As children grow, there are certain milestones parents look forward to, such as crawling, walking and speaking. By their first birthday, most children know a word or two; at 18 months, their vocabulary should consist of five to 20 words and include simple two-word sentences. But these are rough guidelines. Every child progresses at a different pace.

Approximately one out of every four children experiences a speech delay, and most eventually catch up without any sort of intervention.

Still, it’s best to bring up any concerns with your child’s doctor. If there is a language disorder or developmental problem, early treatment is key to preventing learning problems down the road. 

What Are the Reasons for a Speech Delay?

A variety of factors can lead to delayed speech and language skills. These include:

• Hearing loss.
• Oral anatomy (problems with the tongue or soft palate).
• Dysarthria (a disorder involving the muscles that control speech).
• Exposure to multiple languages.
• Neurological disorders such as autism, cerebral palsy and muscular dystrophy.
• Learning disabilities.
• Auditory processing disorders.
• Premature birth.
• Environmental deprivation.

If your child’s doctor cannot rule out a speech delay, a speech-language pathologist should be consulted for a full evaluation. This involves a series of tests that will be used to assess your child’s receptive language and expressive language skills, sound development, speech clarity and oral-motor skills. Speech therapy may be recommended to help your child develop the skills necessary for effective communication. 

What Can Parents Do? 

Both heredity and environment play a role in speech development. As a parent, there are steps you can take to assist your child with speech development. Communicate often (talk and sing), encourage verbal interaction whenever possible and read to your child starting at a young age. 

Call the Center for Hearing & Speech at  (314) 968-4710  for more information or to schedule an appointment.

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Apraxia of Speech

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What is apraxia of speech?

What are the types and causes of apraxia of speech, what are the symptoms of apraxia of speech, how is apraxia of speech diagnosed, how is apraxia of speech treated, what research is being done to better understand apraxia of speech, where can i find additional information about apraxia of speech.

Apraxia of speech (AOS)—also known as acquired apraxia of speech, verbal apraxia, or childhood apraxia of speech (CAS) when diagnosed in children—is a speech sound disorder. Someone with AOS has trouble saying what he or she wants to say correctly and consistently. AOS is a neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain knows what it wants to say, but cannot properly plan and sequence the required speech sound movements.

AOS is not caused by weakness or paralysis of the speech muscles (the muscles of the jaw, tongue, or lips). Weakness or paralysis of the speech muscles results in a separate speech disorder, known as dysarthria . Some people have both dysarthria and AOS, which can make diagnosis of the two conditions more difficult.

The severity of AOS varies from person to person. It can be so mild that it causes trouble with only a few speech sounds or with pronunciation of words that have many syllables. In the most severe cases, someone with AOS might not be able to communicate effectively by speaking, and may need the help of alternative communication methods.

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

• Acquired AOS can affect someone at any age, although it most typically occurs in adults. Acquired AOS is caused by damage to the parts of the brain that are involved in speaking and involves the loss or impairment of existing speech abilities. It may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired AOS may occur together with other conditions that are caused by damage to the nervous system. One of these is dysarthria, as mentioned earlier. Another is aphasia , which is a language disorder. (For more information, see the NIDCD fact sheet Aphasia .)
• Childhood AOS is present from birth. This condition is also known as developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. Childhood AOS is not the same as developmental delays in speech, in which a child follows the typical path of speech development but does so more slowly than is typical. The causes of childhood AOS are not well understood. Imaging and other studies have not been able to find evidence of brain damage or differences in the brain structure of children with AOS. Children with AOS often have family members who have a history of a communication disorder or a learning disability. This observation and recent research findings suggest that genetic factors may play a role in the disorder. Childhood AOS appears to affect more boys than girls.

People with either form of AOS may have a number of different speech characteristics, or symptoms:

• Distorting sounds. People with AOS may have difficulty pronouncing words correctly. Sounds, especially vowels, are often distorted. Because the speaker may not place the speech structures (e.g., tongue, jaw) quite in the right place, the sound comes out wrong. Longer or more complex words are usually harder to say than shorter or simpler words. Sound substitutions might also occur when AOS is accompanied by aphasia.
• Making inconsistent errors in speech. For example, someone with AOS may say a difficult word correctly but then have trouble repeating it, or may be able to say a particular sound one day and have trouble with the same sound the next day.
• Groping for sounds. People with AOS often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly.
• Making errors in tone, stress, or rhythm. Another common characteristic of AOS is the incorrect use of prosody. Prosody is the rhythm and inflection of speech that we use to help express meaning. Someone who has trouble with prosody might use equal stress, segment syllables in a word, omit syllables in words and phrases, or pause inappropriately while speaking.

Children with AOS generally understand language much better than they are able to use it. Some children with the disorder may also have other speech problems, expressive language problems, or motor-skill problems.

Professionals known as speech-language pathologists play a key role in diagnosing and treating AOS. Because there is no single symptom or test that can be used to diagnose AOS, the person making the diagnosis generally looks for the presence of several of a group of symptoms, including those described earlier. Ruling out other conditions, such as muscle weakness or language production problems (e.g., aphasia), can help with the diagnostic process.

In some cases, people with acquired AOS recover some or all of their speech abilities on their own. This is called spontaneous recovery.

Children with AOS will not outgrow the problem on their own. They also do not acquire the basics of speech just by being around other children, such as in a classroom. Therefore, speech-language therapy is necessary for children with AOS as well as for people with acquired AOS who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat AOS, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with AOS. Frequent, intensive, one-on-one speech-language therapy sessions are needed for both children and adults with AOS. (The repetitive exercises and personal attention needed to improve AOS are difficult to deliver in group therapy.) Children with severe AOS may need intensive speech-language therapy for years, in parallel with normal schooling, to obtain adequate speech abilities.

In severe cases, adults and children with AOS may need to find other ways to express themselves. These might include formal or informal sign language; a notebook with pictures or written words that can be pointed to and shown to other people; or an electronic communication device—such as a smartphone, tablet, or laptop computer—that can be used to write or produce speech. Such assistive communication methods can also help children with AOS learn to read and better understand spoken language by stimulating areas of the brain involved in language and literacy.

Researchers are searching for the causes of childhood AOS, including the possible role of abnormalities in the brain or other parts of the nervous system. They are also looking for genetic factors that may play a role in childhood AOS. Other research on childhood AOS aims to identify more specific criteria and new techniques to diagnose the disorder and to distinguish it from other communication disorders.

Research on acquired AOS includes studies to pinpoint the specific areas of the brain that are involved in the disorder. In addition, researchers are studying the effectiveness of various treatment approaches for both acquired and childhood AOS.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Pub. No. 13-7466 September 2016

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Speech and Language Impairments

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

“(11)  Speech or language impairment  means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11]

(Parent Information and Resources Center, 2015)

Table of Contents

What is a Speech and Language Impairment?

Characteristics of speech or language impairments, interventions and strategies, related service provider-slp.

• A Day in the Life of an SLP

Assistive Technology

Speech and language impairment  are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced.

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics.

(Wikipedia, n.d./ Speech and Language Impairment)

*It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool.  With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development.  Distinguishing between the two is most reliably done by a certified speech-language pathologist.  (CPIR, 2015)

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an  articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly

Fluency  refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.”

Voice  is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use.

Language  has to do with meanings, rather than sounds.  A language disorder refers to an impaired ability to understand and/or use words in context. A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

• improper use of words and their meanings,
• inability to express ideas,
• inappropriate grammatical patterns,
• reduced vocabulary, and
• inability to follow directions.

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

(CPIR, 2015)

• Use the (Cash, Wilson, and DeLaCruz, n.d) reading and/or the [ESU 8 Wednesday Webinar] to develop this section of the summary. 

Cash, A, Wilson, R. and De LaCruz, E.(n,d.) Practical Recommendations for Teachers: Language Disorders. https://www.education.udel.edu/wp-content/uploads/2013/01/LanguageDisorders.pdf 

[ESU 8 Wednesday Webinar] Speech Language Strategies for Classroom Teachers.- video below

Video: Speech Language Strategies for Classroom Teachers (15:51 minutes)’

[ESU 8 Wednesday Webinars]. (2015, Nov. 19) . Speech Language Strategies for Classroom Teachers. [Video FIle]. From https://youtu.be/Un2eeM7DVK8

Most, if not all, students with a speech or language impairment will need  speech-language pathology services . This related service is defined by IDEA as follows:

(15)  Speech-language pathology services  include—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

(v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments. [34 CFR §300.34(c)(15)]

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

• individual therapy for the child;
• consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
• work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

A Day in the Life of an SLP

Christina is a speech-language pathologist.  She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie.  He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl  in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning. (CPIR, 2015)

Project IDEAL , suggests two major categories of AT computer software packages to develop the child’s speech and language skills and augmentative or alternative communication (AAC).

Augmentative and alternative communication  ( AAC ) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. Augmentative and alternative communication may used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language. AAC can be a permanent addition to a person’s communication or a temporary aid.

(Wikipedia, (n.d. /Augmentative and alternative communication)

Center for Parent Information and Resources (CPIR)  (2015), Speech and Language Impairments, Newark, NJ, Author, Retrieved 4.1.19 from https://www.parentcenterhub.org/speechlanguage/

Wikipedia (n.d.) Augmentative and alternative communication. From https://en.wikipedia.org/wiki/Augmentative_and_alternative_communication 

Wikipedia, (n.d.) Speech and Language Impairment. From  https://en.wikipedia.org/wiki/Speech_and_language_impairment 

Updated 8.8.23

Understanding and Supporting Learners with Disabilities Copyright © 2019 by Paula Lombardi is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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What is a speech impairment?

A speech impairment refers to an impaired ability to produce speech sounds and may range from mild to severe. It may include an articulation disorder, characterized by omissions or distortions of speech sounds; a fluency disorder, characterized by atypical flow, rhythm, and/or repetitions of sounds; or a voice disorder, characterized by abnormal pitch, volume, resonance, vocal quality, or duration.

The American Speech-Language Hearing Association (ASHA) has published its official definitions in Definitions of Communication Disorders and Variations .

Additional information is available from Speech and Language Impairments  hosted by the Center for Parent Information and Resources.

General Information About Speech and Language Disorders

Definition of speech and language disorders.

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

One quarter of the students served in the public schools’ special education programs (almost 1 million children in the 1993-94 school year) were categorized as having a speech or language impairment. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness. Language disorders may be related to other disabilities such as mental retardation, autism or cerebral palsy. It is estimated that communication disorders (including speech, language and hearing disorders) affect one of every 10 people in the United States.

Characteristics

A child’s communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say “see” when they mean “ski” or they may have trouble using other sounds like “l” or “r”. Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Educational implications

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate timely intervention. While many speech and language patterns can be called “baby talk” and are part of a young child’s normal development, they can become problems if they are not outgrown as expected. In this way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected.

Speech-language pathologists assist children who have communication disorders in various ways. They provide individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and work closely with the family to develop goals and techniques for effective therapy in class and at home. Technology can help children whose physical conditions make communication difficult. The use of electronic communication systems allow nonspeaking people and people with severe physical disabilities to engage in the give and take of shared thought.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and, as students get older, the understanding and use of language becomes more complex. Communication skills are at the heart of the education experience. Speech and/or language therapy may continue throughout a student’s school year either in the form of direct therapy or on a consultant basis. The speech-language pathologist may assist vocational teachers and counselors in establishing communication goals related to the work experiences of students and suggest strategies that are effective for the important transition from school to employment and adult life.

Communication has many components. All serve to increase the way people learn about the world around them, utilize knowledge and skills, and interact with colleagues, family and friends.

Berkowitz, S. (1994). “The cleft palate story: A primer for parents of children with cleft lip and palate.” Chicago, IL: Quintessence. (Telephone: 1-800-621-0387.)

Bernthal, J.E. & Bankson, N.W. (1993). “Articulation and phonological disorders” (3rd ed.). Englewood Cliffs, NJ: Prentice Hall. (Available from Prentice Hall, Englewood Cliffs, NJ 07632. Telephone: 1-800-947-7700.)

Beukelman, D.R., & Mirenda, P. (1992). “Augmentative and alternative communication: Management of severe communication disorders in children and adults.” Baltimore, MD: Paul H. Brookes. (Telephone: 1-800-638-3775.)

Organizations

• Alliance for Technology Access 2175 E. Francisco Blvd., Suite L San Rafael, CA 94901 (415) 455-4575
• American Speech-Language-Hearing Association (ASHA) 10801 Rockville Pike Rockville, MD 20852 (301) 897-5700 (V/TT); 1-800-638-8255 E-Mail: [email protected]
• Learning Disabilities Association of America (LDA) 4156 Library Road Pittsburgh, PA 15234 (412) 341-1515; (412) 341-8077
• Division for Children with Communication Disorders c/o Council for Exceptional Children (CEC) 1920 Association Drive Reston, VA 22091-1589 (703) 620-3660
• National Easter Seal Society 230 West Monroe Street, Suite 1800 Chicago, IL 60606-4802 (312) 726-6200; (312) 726-4258 (TT) 1-800-221-6827 (Toll Free); (312) 726-6200 (312) 726-4258 (TTY) E-Mail: [email protected]
• Scottish Rite Foundation Southern Jurisdiction, U.S.A., Inc. 1733 Sixteenth Street, N.W. Washington, DC 20009-3199 (202) 232-3579
• Trace Research and Development Center University of Wisconsin - Madison S-151 Waisman Center Madison, WI 53705-2280 (608) 262-6966; (608) 263-5408 (TTY)

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Language and Speech Disorders in Children

Helping children learn language, what to do if there are concerns.

• Detecting problems

Children are born ready to learn a language, but they need to learn the language or languages that their family and environment use. Learning a language takes time, and children vary in how quickly they master milestones in language and speech development. Typically developing children may have trouble with some sounds, words, and sentences while they are learning. However, most children can use language easily around 5 years of age.

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as

• Responding to the first sounds, gurgles, and gestures a baby makes.
• Repeating what the child says and adding to it.
• Talking about the things that a child sees.
• Asking questions and listening to the answers.
• Looking at or reading books.
• Telling stories.
• Singing songs and sharing rhymes.

This can happen both during playtime and during daily routines.

Parents can also observe the following:

• How their child hears and talks and compare it with typical milestones for communication skills external icon .
• How their child reacts to sounds and have their hearing tested if they have concerns .

Learn more about language milestones .  Watch milestones in action.

  Top of Page

Some languages are visual rather than spoken. American Sign Language uses visual signals, including gestures, facial expressions, and body movement to communicate.

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

• Not hearing the words (hearing loss).
• Not understanding the meaning of the words.
• Not knowing the words to use.
• Not knowing how to put words together.
• Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Difficulty with forming specific words or sounds correctly.
• Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
• Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

Learn more about language disorders external icon .

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety . Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

Detecting problems with language or speech

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others. Learn more about hearing loss, screening, evaluation, and treatment .

A language development specialist like a speech-language pathologist external icon will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Treatment for language or speech disorders and delays

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention external icon (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

What every parent should know

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) external icon and Section 504 external icon , an anti-discrimination law.

Get help from your state’s Parent Training and Information Center external icon

The role of healthcare providers

Healthcare providers can play an important part in collaborating with schools to help a child with speech or language disorders and delay or other disabilities get the special services they need. The American Academy of Pediatrics has created a report that describes the roles that healthcare providers can have in helping children with disabilities external icon , including language or speech disorders.

More information

CDC Information on Hearing Loss

National Institute on Deafness and Other Communication Disorders external icon

Birth to 5: Watch me thrive external icon

The American Speech-Language-Hearing Association external icon

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