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Speech sound disorder | |
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Specialty | Speech-language pathologist |
A speech sound disorder (SSD) is a speech disorder affecting the ability to pronounce speech sounds, which includes speech articulation disorders and phonemic disorders, the latter referring to some sounds (phonemes) not being produced or used correctly. The term "protracted phonological development" is sometimes preferred when describing children's speech, to emphasize the continuing development while acknowledging the delay.
A study in the United States estimated that amongst 6 years old, 5.3% of African American children and 3.8% of White children have a speech sound disorder. [1]
Speech sound disorders may be further subdivided into two primary types, articulation disorders (also called phonetic production disorders) and phonemic disorders (also called phonological disorders). However, some may have a mixed disorder in which both articulation and phonological problems exist. Though speech sound disorders are associated with childhood, some residual errors may persist into adulthood. Several different sources suggest that 1 to 2% of the young adult population overall continue to present with speech sound disorder errors.
Articulation disorders (also called phonetic production disorders, or simply "artic disorders" for short) are based on difficulty learning to physically produce the intended phonemes. Articulation disorders have to do with the main articulators which are the lips, teeth, alveolar ridge, hard palate, velum, glottis, and the tongue. If the disorder has anything to do with any of these articulators, then it is an articulation disorder. There are usually fewer errors than with a phonemic disorder, and distortions are more likely (though any omissions, additions, and substitutions may also be present). They are often treated by teaching the child how to physically produce the sound and having them practice its production until it (hopefully) becomes natural. Articulation disorders should not be confused with motor speech disorders, such as dysarthria (in which there is actual paralysis of the speech musculature) or developmental verbal dyspraxia (in which motor planning is severely impaired).
In a phonemic disorder (also called a phonological disorder) the child is having trouble learning the sound system of the language, failing to recognize which sound-contrasts also contrast meaning. For example, the sounds /k/ and /t/ may not be recognized as having different meanings, so "call" and "tall" might be treated as homophones, both being pronounced as "tall." This is called phoneme collapse, and in some cases many sounds may all be represented by one — e.g., /d/ might replace /t/, /k/, and /ɡ/. As a result, the number of error sounds is often (though not always) greater than with articulation disorders and substitutions are usually the most common error. Phonemic disorders are often treated using minimal pairs (two words that differ by only one sound) to draw the child's attention to the difference and its effect on communication.
Some children with phonemic disorders can hear that two phonemes are different from each other when others speak, but are not aware that those phonemes sound the same when they themselves speak. This is called the fis phenomenon , after a scenario in which a speech pathologist says, "You said 'fis,' did you mean 'fish'?" And the child responds, "No, I didn't say 'fis,' I said 'fis'." In some cases, a child is making sounds, that, while similar, are acoustically distinct. Others don’t hear that difference, however, [7] because the two sounds are not treated as separate phonemes in the language being spoken.
Though phonemic disorders are often considered language disorders in that it is the language system that is affected, they are also speech sound disorders in that the errors relate to the use of phonemes. This makes them different from specific language impairment , which is primarily a disorder of the syntax (grammar) and usage of language rather than the sound system. However, the two can coexist, affecting the same person.
Other disorders can deal with a variety of different ways to pronounce consonants. Some examples are glides and liquids. Glides occur when the articulatory posture changes gradually from consonant to vowel. Liquids can include /l/ and /ɹ/.
In some cases phonetic and phonemic errors may coexist in the same person. In such case the primary focus is usually on the phonological component but articulation therapy may be needed as part of the process, since teaching a child how to use a sound is not practical if the child does not know how to produce it.
Even though most speech sound disorders can be successfully treated in childhood, and a few may even outgrow them on their own, errors may sometimes persist into adulthood rather than only being not age appropriate. Such persisting errors are referred to as "residual errors" and may remain for life.
Errors produced by children with speech sound disorders are typically classified into four categories:
Sometimes, even for experts, telling exactly which type has been made is not obvious — some distorted forms of /ɹ/ may be mistaken for /w/ by a casual observer, yet may not actually be either sound but somewhere in between. Further, children with severe speech sound disorders may be difficult to understand, making it hard to tell what word was actually intended and thus what is actually wrong with it. Some terms can be used to describe more than one of the above categories, such as lisp, which is often the replacement of /s/ with /θ/ (a substitution), but can be a distortion, producing /s/ just behind the teeth resulting in a sound somewhere between /s/ and /θ/.
There are three different levels of classification when determining the magnitude and type of an error that is produced:
Note that omissions do not mean the sound cannot be produced, and some sounds may be produced more easily or frequently when appearing with certain other sounds: someone might be able to say "s" and "t" separately, but not "st," or may be able to produce a sound at the beginning of a word but not at the end. The magnitude of the problem will often vary between different sounds from the same speaker.
Speech sound disorders (SSDs) can arise from a variety of causes, which are generally categorized into organic and functional factors:
Organic causes
These include physical or neurological issues that affect speech production:
Functional causes
These are cases where there is no identifiable physical cause:
Other influences
Identifying the underlying cause is key to determining the appropriate intervention.
According to a cross-linguistic study across 27 languages, children acquire most consonants by 5. On average, all plosives, nasals, and glides were acquired by 3yrs 11mo; all affricates were acquired by 4yrs 11mo; all liquids were acquired by 5yrs11mo; and all fricatives were acquired by 6yrs 11mo (90% criterion). When a child continues to have issues with articulation beyond typical age, it is recommended to speech a speech-language pathologist. Misarticulation of certain difficult sounds ([ l ], [ ɹ ], [ s ], [ z ], [ θ ], [ ð ], [ t͡ʃ ], [ d͡ʒ ], and [ ʒ ]) may be normal up to 8 years.
Diagnosing a speech sound disorder involves a structured process that includes the following steps:
This comprehensive assessment allows the SLP to develop an individualized treatment plan tailored to the child’s specific needs.
For most children, the disorder is not lifelong and speech difficulties improve with time and speech-language treatment. Prognosis is poorer for children who also have a language disorder, as that may be indicative of a learning disorder. [8]
There are several treatments available which depends on the cause of speech sound disorders:
A certified speech-language pathologist should make a full assessment and diagnosis to indicate appropriate therapy. When a speech-language pathologist trains parents to implement language and communication intervention techniques this can improved outcome for children. [9]
In linguistics, a liquid consonant or simply liquid is any of a class of consonants that consists of rhotics and voiced lateral approximants, which are also sometimes described as "R-like sounds" and "L-like sounds". The word liquid seems to be a calque of the Ancient Greek word ὑγρός, initially used by grammarian Dionysius Thrax to describe Greek sonorants.
A phoneme is any set of similar speech sounds that is perceptually regarded by the speakers of a language as a single basic sound—a smallest possible phonetic unit—that helps distinguish one word from another. All languages contains phonemes, and all spoken languages include both consonant and vowel phonemes. Phonemes are primarily studied under the branch of linguistics known as phonology.
Wernicke's aphasia, also known as receptive aphasia, sensory aphasia, fluent aphasia, or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent speech, which is characterized by typical speech rate, intact syntactic abilities and effortless speech output. Writing often reflects speech in that it tends to lack content or meaning. In most cases, motor deficits do not occur in individuals with Wernicke's aphasia. Therefore, they may produce a large amount of speech without much meaning. Individuals with Wernicke's aphasia often suffer of anosognosia – they are unaware of their errors in speech and do not realize their speech may lack meaning. They typically remain unaware of even their most profound language deficits.
A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and non-verbal communication styles. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language. This article covers subjects such as diagnosis, the DSM-IV, the DSM-V, and examples like sensory impairments, aphasia, learning disabilities, and speech disorders.
Speech disorders, impairments, or impediments, are a type of communication disorder in which normal speech is disrupted. This can mean fluency disorders like stuttering, cluttering or lisps. Someone who is unable to speak due to a speech disorder is considered mute. Speech skills are vital to social relationships and learning, and delays or disorders that relate to developing these skills can impact individuals function. For many children and adolescents, this can present as issues with academics. Speech disorders affect roughly 11.5% of the US population, and 5% of the primary school population. Speech is a complex process that requires precise timing, nerve and muscle control, and as a result is susceptible to impairments. A person who has a stroke, an accident or birth defect may have speech and language problems.
Non-native pronunciations of English result from the common linguistic phenomenon in which non-native speakers of any language tend to transfer the intonation, phonological processes and pronunciation rules of their first language into their English speech. They may also create innovative pronunciations not found in the speaker's native language.
In phonetics, palatalization or palatization is a way of pronouncing a consonant in which part of the tongue is moved close to the hard palate. Consonants pronounced this way are said to be palatalized and are transcribed in the International Phonetic Alphabet by affixing the letter ⟨ʲ⟩ to the base consonant. Palatalization is not phonemic in English, but it is in Slavic languages such as Russian and Ukrainian, Finnic languages such as Estonian and Võro, Irish, Marshallese, Kashmiri, and Japanese.
Labialization is a secondary articulatory feature of sounds in some languages. Labialized sounds involve the lips while the remainder of the oral cavity produces another sound. The term is normally restricted to consonants. When vowels involve the lips, they are called rounded.
In phonetics, nasalization is the production of a sound while the velum is lowered, so that some air escapes through the nose during the production of the sound by the mouth. An archetypal nasal sound is.
Phonological awareness is an individual's awareness of the phonological structure, or sound structure, of words. Phonological awareness is an important and reliable predictor of later reading ability and has, therefore, been the focus of much research.
Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech – as distinct from language – is the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language.
Speech is the use of the human voice as a medium for language. Spoken language combines vowel and consonant sounds to form units of meaning like words, which belong to a language's lexicon. There are many different intentional speech acts, such as informing, declaring, asking, persuading, directing; acts may vary in various aspects like enunciation, intonation, loudness, and tempo to convey meaning. Individuals may also unintentionally communicate aspects of their social position through speech, such as sex, age, place of origin, physiological and mental condition, education, and experiences.
Speech–language pathology is a healthcare and academic discipline concerning the evaluation, treatment, and prevention of communication disorders, including expressive and mixed receptive-expressive language disorders, voice disorders, speech sound disorders, speech disfluency, pragmatic language impairments, and social communication difficulties, as well as swallowing disorders across the lifespan. It is an allied health profession regulated by professional bodies including the American Speech-Language-Hearing Association (ASHA) and Speech Pathology Australia. The field of speech-language pathology is practiced by a clinician known as a speech-language pathologist (SLP) or a speech and language therapist (SLT). SLPs also play an important role in the screening, diagnosis, and treatment of autism spectrum disorder (ASD), often in collaboration with pediatricians and psychologists.
Paraphasia is a type of language output error commonly associated with aphasia and characterized by the production of unintended syllables, words, or phrases during the effort to speak. Paraphasic errors are most common in patients with fluent forms of aphasia, and come in three forms: phonemic or literal, neologistic, and verbal. Paraphasias can affect metrical information, segmental information, number of syllables, or both. Some paraphasias preserve the meter without segmentation, and some do the opposite. However, most paraphasias affect both partially.
Apraxia of speech (AOS), also called verbal apraxia, is a speech sound disorder affecting an individual's ability to translate conscious speech plans into motor plans, which results in limited and difficult speech ability. By the definition of apraxia, AOS affects volitional movement pattern. However, AOS usually also affects automatic speech.
Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.
Jargon aphasia is a type of fluent aphasia in which an individual's speech is incomprehensible, but appears to make sense to the individual. Persons experiencing this condition will either replace a desired word with another that sounds or looks like the original one, or has some other connection to it, or they will replace it with random sounds. Accordingly, persons with jargon aphasia often use neologisms, and may perseverate if they try to replace the words they can not find with sounds.
Speech acquisition focuses on the development of vocal, acoustic and oral language by a child. This includes motor planning and execution, pronunciation, phonological and articulation patterns.
Developmental verbal dyspraxia (DVD), also known as childhood apraxia of speech (CAS) and developmental apraxia of speech (DAS), is a condition in which an individual has problems saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts needed for speech. The individual knows what they want to say, but their brain has difficulty coordinating the muscle movements necessary to say those words.
A lisp is a speech impairment in which a person misarticulates sibilants. These misarticulations often result in unclear speech in languages with phonemic sibilants.
rhotacism for difficulty on the r sounds