Neurological Disorders What Is a Speech Sound Disorder? By Elizabeth Plumptre Elizabeth Plumptre LinkedIn Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences. Learn about our editorial process Published on March 18, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Halfpoint Images / Getty Images Table of Contents View All Table of Contents Symptoms Diagnosis Causes Types Treatment Speech sound disorders are a blanket description for a child’s difficulty in learning, articulating, or using the sounds/sound patterns of their language. These difficulties are usually clear when compared to the communication abilities of children within the same age group. Speech developmental disorders may indicate challenges with motor speech. Here, a child experiences difficulty moving the muscles necessary for speech production. This child may also face reduced coordination when attempting to speak. Speech sound disorders are recognized where speech patterns do not correspond with the movements/gestures made when speaking. Speech impairments are a common early childhood occurrence—an estimated 2% to 13% of children live with these difficulties.Children with these disorders may struggle with reading and writing. This can interfere with their expected academic performance. Speech sound disorders are often confused with language conditions such as specific language impairment (SLI). This article will examine the distinguishing features of this disorder. It will also review factors responsible for speech challenges, and the different ways they can manifest. Lastly, we’ll cover different treatment methods that make managing this disorder possible. Types of Speech Impediments Symptoms of Speech Sound Disorder A speech sound disorder may manifest in different ways. This usually depends on the factors responsible for the challenge, or how extreme it is. There are different patterns of error that may signal a speech sound disorder. These include: Stuttering Removing a sound from a word Including a sound in a word Replacing hard to pronounce sounds with an unsuitable alternative Difficulty pronouncing the same sound in different words (e.g., "pig" and "kit") Repeating sounds or words Lengthening words Pauses while speaking Tension when producing sounds Head jerks during speech Blinking while speaking Shame while speaking Changes in voice pitch Raspiness Running out of breath while speaking It’s important to note that children develop at different rates. This can reflect in the ease and ability to produce sounds. But where children repeatedly make sounds or statements that are difficult to understand, this could indicate a speech disorder. Diagnosis of Speech Sound Disorders For a correct diagnosis, a speech-language pathologist can determine whether or not a child has a speech-sound disorder. This determination may be made in line with the requirements of the DSM-5 diagnostic criteria. These guidelines require that: The child experience persistent difficulty with sound production (this affects communication and speech comprehension) Symptoms of the disorder appear early during the child’s development stages This disorder limits communication. It affects social interactions, academic achievements, and job performance. The disorder is not caused by other conditions like a congenital disorder or an acquired condition like hearing loss. Hereditary disorders are, however, exempted. Causes of Speech Sound Disorders There is no known cause of speech sound disorders. However, several risk factors may increase the odds of developing a speech challenge. These include: Gender: Male children are more likely to develop a speech sound disorder Family history: Children with family members living with speech disorders may acquire a similar challenge. Socioeconomics: Being raised in a low socioeconomic environment may contribute to the development of speech and literacy challenges. Pre- and post-natal challenges: Difficulties faced during pregnancy such as maternal infections and stressors may worsen the chances of speech disorders in a child. Likewise, delivery complications, premature birth, and low-birth-weight could lead to speech disorders. Disabilities: Down syndrome, autism, and other disabilities may be linked to speech-sound disorders. Physical challenges: Children with a cleft lip may experience speech sound difficulties. Brain damage: These disorders may also be caused by an infection or trauma to a child’s brain. This is seen in conditions like cerebral palsy where the muscles affecting speech are injured. The Evidence is Adding Up: All Head Impacts Have Consequences Types of Speech Sound Disorders By the time a child turns three, at least half of what they say should be properly understood. By ages four and five, most sounds should be pronounced correctly—although, exceptions may arise when pronouncing “l”, “s”,”r”,”v”, and other similar sounds. By seven or eight, harder sounds should be properly pronounced. A child with a speech sound disorder will continue to struggle to pronounce words, even past the expected age. Difficulty with speech patterns may signal one of the following speech sound disorders: Disfluency This refers to interruptions while speaking. Stuttering is the most common form of disfluency. It is recognized for recurring breaks in the free flow of speech. After the age of four, a child with disfluency will still repeat words or phrases while speaking. This child may include extra words or sounds when communicating—they may also make words longer by stressing syllables. This disorder may cause tension while speaking. Other times, head jerking or blinking may be observed with disfluency. Children with this disorder often feel frustrated when speaking, it may also cause embarrassment during interactions. Articulation Disorder When a child is unable to properly produce sounds, this may be caused by inexact placement, speed, pressure, or movement from the lips, tongue, or throat. This usually signals an articulation disorder, where sounds like “r”, “l”, or “s” may be changed. In these cases, a child’s communication may be understood by only close family members. Phonological Disorder A phonological disorder is present where a child is unable to make the speech sounds expected of their age. Here, mistakes may be made when producing sounds. Other times, sounds like consonants may be omitted when speaking. Voice Disorder Where a child is observed to have a raspy voice, this may be an early sign of a voice disorder. Other indicators include voice breaks, a change in pitch, or an excessively loud or soft voice. Children that run out of breath while speaking may also live with this disorder. Likewise, children may sound very nasally, or can appear to have inadequate air coming out of their nose if they have a voice disorder. Apraxia Childhood apraxia of speech occurs when a child lacks the proper motor skills for sound production. Children with this condition will find it difficult to plan and produce movements in the tongue, lips, jaw, and palate required for speech. Treatment of Speech Sound Disorder Parents of children with speech sound disorders may feel at a loss for the next steps to take. To avoid further strain to the child, it’s important to avoid showing excessive concern. Instead, listening patiently to their needs, letting them speak without completing their sentences, and showing usual love and care can go a long way. For professional assistance, a speech-language pathologist can assist with improving a child’s communication. These pathologists will typically use oral motor exercises to enhance speech. These oral exercises may also include nonspeech oral exercises such as blowing, oral massages and brushing, cheek puffing, whistleblowing, etc. Nonspeech oral exercises help to strengthen weak mouth muscles, and can help with learning the common ways of communicating. Parents and children with speech sound disorders may also join support groups for information and assistance with the condition. A Word From Verywell It can be frustrating to witness the challenges in communication. But while it's understandable to long for typical communication from a child—the differences caused by speech disorders can be managed with the right care and supervision. Speaking to a speech therapist, and showing love o children with speech disorders can be important first steps in overcoming these conditions. 12 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Eadie P, Morgan A, Ukoumunne OC, Ttofari Eecen K, Wake M, Reilly S. Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children. Dev Med Child Neurol. 2015;57(6):578-584. doi:10.1111/dmcn.12635 McLeod S, Harrison LJ, McAllister L, McCormack J. Speech sound disorders in a community study of preschool children. Am J Speech Lang Pathol. 2013;22(3):503-522. doi:10.1044/1058-0360(2012/11-0123) Murphy CF, Pagan-Neves LO, Wertzner HF, Schochat E. Children with speech sound disorder: comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills. Front Psychol. 2015;6:64. Published 2015 Feb 4. doi:10.3389/fpsyg.2015.00064 Penn Medicine. Speech and Language Disorders-Symptoms and Causes. PsychDB. Speech Sound Disorder (Phonological Disorder). Sices L, Taylor HG, Freebairn L, Hansen A, Lewis B. Relationship between speech-sound disorders and early literacy skills in preschool-age children: impact of comorbid language impairment. J Dev Behav Pediatr. 2007;28(6):438-447. doi:10.1097/DBP.0b013e31811ff8ca American Speech-Language-Hearing Association. Speech Sound Disorders: Articulation and Phonology. American Speech-Language-Hearing Association. Speech Sound Disorders. MedlinePlus. Phonological Disorder. National Institute on Deafness and Other Communication Disorders. Articulation Disorder. National Institute of Health. Phonological Disorder. Lee AS, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database Syst Rev. 2015;2015(3):CD009383. Published 2015 Mar 25. doi:10.1002/14651858.CD009383.pub2 By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences. 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