Speech, Articulation &
Phonological Disorders

Speech production requires precisely coordinated muscle actions of the tongue, lips, jaw, and vocal tract to produce the recognizable sounds that make up language.

If a child's conversational speech is judged hard to understand, and scores on articulation testing are below the normative standards, the speech pathologist must determine whether the child is showing a primarily articulatory deficit or has a more phonologically based disorder. A speech problem is considered articulatory if it involves errors that are mostly distortions. When deletion and substitution errors are present, the disorder is considered primarily phonological.

For a true articulation disorder, a traditional approach targeting specific sounds is recommended. If phonological errors are present, or a combination of phonetic and phonological issues, a phonological or language-based approach is recommended. The best way to look for these patterns is to collect a sample of the child's spontaneous speech and analyze how the child is producing sounds in all word positions. There may be rule-governed patterns to their speech production that are identified and resolved with treatment. Working on the pattern error rather than the correct production of a specific sound serves to reinforce correct phonological development.

Speech production deficits that result from impairment of the neuromuscular and/or motor control system are identified as motor speech disorders, and may co-occur with other language difficulties. Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS demonstrate difficulty with producing speech at the sound, syllable, and word level. The child knows what he or she wants to say, but his or her brain has difficulty coordinating the muscle movements necessary to say those words. This is due to the brain’s inability to support the planning, sequencing, and coordination of muscle movements for speech production. CAS is a disorder of speech coordination, not strength.

Every child with unintelligible speech can benefit from a thorough language assessment, as there may be additional areas of linguistic development that are hard to detect because the child is hard to understand. Research suggests that children with speech sound disorders are more likely to present with language disorders than their age matched peers. Early detection and treatment of speech problems can reduce later language difficulties.