What exactly is a speech problem?

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So your child has a speech problem. But what exactly is a speech problem? For this post I’m talking about problems with speech sounds and pronunciation. Having a lisp. Or saying tar when you mean car. Or speech that sounds slurred or strained. Other speech problems would be stuttering or stammering. I’ve written other posts about that. If your pre-schoolchild starts to stutter, you can read this. If your family speaks 2 languages or more, and you’re worried about your child stuttering, you can read this. Voice problems like being hoarse are another kind of speech problem which I’ll be covering in a future post.

 

There’s a lot of theoretical discussion in speech and language therapy about how to classify the different types of speech sound problems. There’s no universally agreed upon one yet. I’m sharing with you the one I use to teach speech and language therapists in training. The idea is that any child’s speech sound problem should be able to fit into the system. Essentially there are 7 possibilities and 1 exception when it comes to children’s speech sound problems. So let’s get started!

 # 1 Articulation Impairment- in the mouth

This is where your child has trouble producing particular sounds, usually /s/ or /r/. For English speakers this can be a lisp (technically called an inter-dental /s/). Usually /s/ is made with the tip of your tongue up behind your front teeth. With a lisp, your tongue comes between your teeth. I had a lisp until I was 17 and had no idea I had one until I visited a local speech & language therapist to find out about training to be one!! I couldn’t make a /s/ with my tongue tip behind my front teeth. So I make my /s/ with my tongue tip behind my lower teeth. My little girl has a lisp too. I think it’s really cute for now! She has no front teeth though so I’m waiting to see what happens when her permanent teeth come in. For /s/, the air is directed out of the center of your mouth. Make one and see if you can put your focus on what’s happening in your mouth when you do. Then try and do a lisp. Another articulation impairment affecting the /s/ sound is when the air comes out the sides of the tongue- often called a lateral lisp. Both of these sounds are not speech sounds in English which can be another way of working out that your child has an articulation impairment (and they only speak English).

 

An articulation impairment can also affect /r/ so your child might say wed when they mean red. If you ask them to say /r/, they can’t do it. Same applies for the /s/. A general rule of thumb is that articulation impairments are in the mouth- a problem with the physical articulation of sounds. The meaning of words is generally not affected so it won’t necessarily be harder to understand your child because their meaning will still be clear.

 

Problems with /r/ are a little more complex in that meaning is affected. Wed and red do not mean the same thing.  So I tend to think of problems with /r/ as an articulation impairment with phonological consequences. Bear with me- I’ll explain more about phonology in # 2 below!

 

Speech therapy for articulation impairments is basically showing your child how to produce the sound by itself. This involves explaining how to make the sound. Then the sound is combined with a vowel. Either a vowel first followed by the /s/ for example, ee-s. Or the /s/ first followed by the vowel, s-ee. Then the sound in words- either at the beginning (son) or the end (house). Then in phrases and sentences and ultimately in spontaneous speech when it has become automatic. I got rid of my lisp by saying the prayers at Mass out loud until I could do it without thinking about it!! Some researchers say that your child would need to be at least age 7 and really committed to changing their speech for therapy to work. It’s a lot of drill work and practice so motivation is important. Here’s a handy table with ages at which you can expect most children to say particular sounds- interpret flexibly though as there is a lot of individual variation. These are from Australia and not written in stone- use as a rough guide.

Next up is

 #2 Phonological Delay: in the mind

Big word phonology! ‘What the hell is that?’ you may be wondering. It has to do with the organisation of sounds and meaning. It’s about rules. So for example knowing that in English you can have str at the beginning of words like strawberry but not nd at the start of words. If you do crosswords a lot, you’ll recognise patterns like this and use the knowledge to work out what the answer might be.

 

Sounds are organised in classes to do with shared properties so we have long sounds like /s/ /z/ /f/ /v/ and short sounds like /t/ /d/ /p//b/. If you say them yourself, you’ll feel the difference. There are front sounds /t/ /d/ /n/ and back sounds /k/ /g/ and the sound at the end of words like sing. There are quiet sounds like /p/ and /t/ and loud sounds like /b/ and /d/.  To feel this difference, put your fingers on your throat and say a long /s/. Then say a long /z/. You should be able to feel a difference with some slight vibration on the /z/.

 

Children who have a phonological impairment might say deben instead of seven.  Or tar when they mean car. Or boon when they mean spoon. If your child has a phonological impairment, this means that they have trouble with learning the rules of their language. (This learning the rules is happening unconsciously). In a way, it’s a language problem that affects the organising of speech sounds into a system of sound contrasts. The contrast is important because that’s connected to the meaning of words. If you want tea, you need to be able to say tea and not have key come out instead.

 

There are 2 kinds of phonological impairment. The first one is phonological delay. So for children who speak English as their only language, the ages and stages of speech development are fairly clearly mapped out. When they’re learning to speak intelligibly (takes up until about age 5 and possibly up to age 8), they make predictable and acceptable errors. For example aminal instead of animal, hopsital instead of hospital. We expect them to make errors like leaving out the last consonant in a word when they are between 18 and 24 months. In fact in this time period they may be making all of these errors at the same time:

  • leaving out one of the consonants where two come together: boon for spoon
  • saying tat when they mean cat
  • saying tar when they mean car.
  • saying dit when they mean sit
  • saying wed when they mean red
  • saying door when they mean tore and
  • saying gog when they mean dog

 

And that’s typical development! No need to correct them. The best thing to do is to repeat the words correctly after them in a natural sounding way. Here’s a very quick video I’ve made to show you how to do this.

 

A phonological delay then is when these kinds of errors don’t go away at the ages you’d expect them to. (There’s a lot of individual variation in early child speech and language development so it’s important to think of the ages and stages in a flexible way). So if your child’s 3 and a half and is still leaving out the consonants at the ends of words. Or they’re 6 and saying sawn when they mean Seán. And here’s another handy table with general ages at which these error patterns (also known as phonological processes) should be gone by. But remember, speech development for multilingual children won’t be exactly the same as this because of the language systems interacting.

The next one is:

 

# 3 Consistent Phonological Disorder

Some errors that children make are not found in typical development. (I’m talking about monolingual English speakers here. It’s slightly different when you speak two or more languages.) Things like leaving out the first sound in a word or the middle sounds in words or using a back sound instead of a front sound. That would be saying kar when they mean tar. This is called a phonological disorder. There are 2 kinds of phonological disorder. The first one is a consistent phonological disorder where your child says the word wrong the same way each time. So it’s always kar for tar. There’s still a consistent pattern in the errors.

 

Speech therapy for phonological delay and consistent phonological disorder focuses on helping children organise their speech sound system and learn the rules. So it would mean talking about long sounds and short sounds for example. Having your child listen and identify long and short sounds and then producing long and short sounds. They would play games where they pick a picture from a pile of pictures with word pairs such like sick (long sound at the start) and tick (short sound at the start). The therapist can’t see which picture. Your child says the name of the picture and the therapist points to the one she hears. The idea is that if your child says tick and the therapist points to tick,  but your child meant sick, they realise that they need to use a short sound instead.

 

# 4 Inconsistent speech disorder

 The other type is an inconsistent speech disorder. The problem here is with selecting and sequencing speech sounds correctly. It means that your child will say the same target word (the word they’re trying to say) differently each time they say it. So seven might be teben, deben, seben. You can see how this makes it hard to understand your child because there’s no predictable pattern in their speech. Things change constantly.

 

The therapy for an inconsistent speech disorder is called. It the core vocabulary approach and works like this. The therapist together with you, your child, and your child’s teacher make a list of 50-70 words that are meaningful to your child and that they’ll have an opportunity to use in day to day interactions. Words like people’s names, pets’ names, foods, favourite things, words like sorry and please and thank you. Generally, your child attends for 2 thirty minute sessions in a week over the course of 6-8 weeks. The first goal is to get their best production. It doesn’t have to be the same as yours. It just has to be consistent so that they’re always saying a word the same way. That will make it easier to understand them and for them to experience successful communication. That’s the first step and it goes on from there.

 

#5 Childhood Apraxia of Speech (previously known as Developmental Verbal Dyspraxia or developmental dyspraxia.

This is a difficult one to explain. The technical description says it’s a difficulty planning and programming movement sequences resulting in errors in speech sound production and prosody. I know! What would that sound like though? Well if your child is very hard to understand, has trouble producing many consonant and vowels, has trouble saying long words, and has unusual sounding speech, then they may have childhood apraxia of speech.

 

It affects 1-2 children per 1000. There are a range of interventions for children with CAS. Two that I have used are the Nuffield Centre Dyspraxia Programme and the Kaufman Speech to Language Protocol which is a little like Core Vocabulary. One early aim is to get consistent production of your child’s best attempt at the words they’re aiming to say. There’s unpublished case study data on the website to show it works. As for the Nuffield programme, there’s published and unpublished evidence about it.

 

#6 Childhood Dysarthria

This means weakness or slowness or poor coordination of speech movements. It can affect your child’s breathing, vocal quality, muscle tone, nasal-sounding speech or, slurred-sounding speech. It’s not as common as the other types. It’s caused by neurological impairment which could occur during or after birth like cerebral palsy. Intervention for children with childhood dysarthria depends on the type of dysarthria, how severe it is, and on what aspects of speech are involved.

 

#7 A combination of issues

Children’s speech may fit neatly into one category. For example, your child has a lisp or articulation impairment and that’s it. However, because children’s speech sound systems and their language is developing, they may have trouble in other areas too. So for example,  your child may have dysarthria related to cerebral palsy and trouble with the physical production of speech sounds, they may also have a phonological impairment.  Or they have a cleft palate affecting their speech (nasal sounding) and a phonological delay, not related to the cleft palate. So while I’ve presented the types separately, it’s not as simple as that in reality. The idea is that SLTs need a system to explain your child’s speech symptoms so they can plan intervention according to their understanding of the type of speech problem it is. So if your child has a lisp, they need articulation intervention. And so on. The intervention needs to fit with the diagnosis.

 

The exception

There’s another category called speech difference. And this is an important one for families who speak two languages or more. If you’ve read my post on what you need to know about speech development for multilingual families (here ), then you’ll know all about languages interacting and how ultimately with high quality input and opportunities to use all of their languages, the speech of most multilingual children develops without problems. What can make it a little more challenging to identify one of the speech problems above is that the languages interact in ways that can produce errors that would be considered a disorder in monolingual English speakers. For example, leaving out the first sounds in words is unusual in monolingual English speaking children but not unusual for French speaking children. That’s why multilingual children need to be assessed in all of their languages and why SLTs need to find out about the different sounds in the different languages they try to work out if there is a problem or not. They call this difference vs disorder in the literature.

Lastly, accents are not speech problems. Everyone has an accent whether they think they do or not! The fancy word for it is idiolect and it includes language as well as speech. So for example I say I do be talking to her. Or I’m after burning the dinner. These are common for some Irish English speakers and artefacts from the Irish language. It’s also common for Irish English speakers to sound like they’re saying dis, dat, dese, and dose  for this, that, these, and those . If you live in South London, you might say souf for south and it’s dialect not a diagnosis! In the US, for Tuesday you say toosday. In Ireland we say chewsday! Tomayto, tomato! Accent is not a speech sound problem.  And no accent is better or worse than any other. Now, if you’re an adult who learned a second language later in life and you feel that your accent is interfering with getting your message across, then a speech and language therapist can help you although it’s important to know that this an area that is only beginning to emerge in speech and language therapy practice and not without controversy. If you want to read more about accents and speaking two languages or more, here are two interesting articles by the renowned Francois Grosjean. (You can read them here and here.

 

If you’re concerned that your child has a speech problem, be sure to contact your local services.

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Let’s get talking!

MP

 

Inspired by:

Barbara Dodd (2005) Differential diagnosis and treatment of children with speech disorders. London: Whurr.

McLeod & Baker (2017) Children’s speech: An evidence-based approach to assessment and intervention. London: Pearson.

2 Comments

  1. Found that very helpful, thank you

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