Speech Sound Disorders: Articulation and Phonological Processes
Courtesy of ASHA

Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns).

An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.

Young children often make speech errors. For instance, many young children sound like they are making a "w" sound for an "r" sound (e.g., "wabbit" for "rabbit") or may leave sounds out of words, such as "nana" for "banana." The child may have an articulation disorder if these errors continue past the expected age.

Not all sound substitutions and omissions are speech errors. Instead, they may be related to a feature of a dialect or accent. For example, speakers of African American Vernacular English (AAVE) may use a "d" sound for a "th" sound (e.g., "dis" for "this"). This is not a speech sound disorder, but rather one of the phonological features of AAVE.

What are some signs of a phonological disorder?

A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like "k" and "g" for those in the front of the mouth like "t" and "d" (e.g., saying "tup" for "cup" or "das" for "gas").

Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don't follow this rule and say only one of the sounds ("boken" for broken or "poon" for spoon), it is more difficult for the listener to understand the child. While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.

How are speech sound disorders diagnosed?

A speech-language pathologist (SLP) is the professional that evaluates children or adults with speech and language difficulties. The SLP listens to the person and may use a formal articulation test to record sound errors. An oral mechanism examination is also done to determine whether the muscles of the mouth are working correctly. The SLP may recommend speech treatment if the sound is not appropriate for the child's age or if it is not a feature of a dialect or accent. For children, the SLP often also evaluates their language development to determine overall communication functioning.

What if I speak more than one language? Is my accent a speech sound disorder?

An accent is the unique way that speech is pronounced by a group of people speaking the same language. Accents are a natural part of spoken languages. It is important to realize that no accent is better than another. Accents are NOT a speech or language disorder. An SLP can work on accent modification services if a client wishes to reduce or modify his or her accent.

What treatments are available for people with speech sound disorders?

SLPs provide treatment to improve articulation of individual sounds or reduce errors in production of sound patterns.

Articulation treatment may involve demonstrating how to produce the sound correctly, learning to recognize which sounds are correct and incorrect, and practicing sounds in different words. Phonological process treatment may involve teaching the rules of speech to individuals to help them say words correctly.

How Does Your Child Hear and Talk?

By: American Speech-Language-Hearing Association via Reading Rockets

Every child is unique and has an individual rate of development. This chart represents, on average, the age by which most children will accomplish skills in hearing, understanding, and talking.

Children typically do not master all items in a category until they reach the upper age in each age range. Just because your child has not accomplished one skill within an age range does not mean your child has a disorder. However, if you have answered no to the majority of items in an age range, seek the advice of an ASHA-certified speech-language pathologist or audiologist.

	Hearing and Understanding	Talking
Birth-3 Months	Startles to loud sounds. Quiets or smiles when spoken to. Seems to recognize your voice and quiets if crying. Increases or decreases sucking behavior in response to sound.	Makes pleasure sounds (cooing, gooing). Cries differently for different needs. Smiles when sees you.
4-6 Months	Moves eyes in direction of sounds. Responds to changes in tone of your voice. Notices toys that make sounds. Pays attention to music.	Babbling sounds more speech-like with many different sounds, including p, b, and m. Chuckles and laughs. Vocalizes excitement and displeasure. Makes gurgling sounds when left alone and when playing with you.
7-12 Months	Enjoys games like peek-a-boo and pat-a-cake. Turns and looks in direction of sounds. Listens when spoken to. Recognizes words for common items like "cup," "shoe," "juice," "book." Begins to respond to requests ("Come here," "Want more?").	Babbling has both long and short groups of sounds such as "tata upup bibibibi." Uses speech or non-crying sounds to get and keep attention. Uses gestures to communicate (waving, holding arms to be picked up). Imitates different speech sounds. Has 1 or 2 words (hi, dog, dada, mama) around first birthday, although all sounds may not be clear.
1-2 Years	Points to a few body parts when asked. Follows single directions and understands simple questions ("Roll the ball," "Kiss the baby," "Where's your shoe?"). Listens to simple stories, songs, and rhymes. Points to pictures in a book when named.	Says more words every month. Uses some 1-2-word questions ("where kitty?" "go bye-bye?" "what's that?"). Puts 2 words together ("more cookie," "no juice," "mommy book"). Uses many different consonant sounds at the beginning of words.
2-3 Years	Understands differences in meaning ("go-stop," "in-on," "big-little," "up-down"). Follows two requests ("Get the book and put it on the table"). Listens to and enjoys hearing stories for longer periods of time.	Has a word for almost everything. Uses 2-3-words to talk about and ask for things. Uses k, g, f, t, d, and n sounds. Speech is understood by familiar listeners most of the time. Often asks for or directs attention to objects by naming them.
3-4 Years	Hears you when you call from another room. Hears television or radio at the same loudness level as other family members. Answers simple "who?," "what?," "where?," "why?" questions.	Talks about activities at school or at friends' homes. People outside family usually understand child's speech. Uses a lot of sentences that have 4 or more words. Usually talks easily without repeating syllables or words.
4-5 Years	Pays attention to short stories and answers simple questions about them. Understands words that involve sequencing (first, next, last) and time (yesterday, today, tomorrow). Hears and understands most of what is said at home and in school.	Uses sentences that give lots of details ("The biggest peach is mine"). Tells stories that stick to topic. Communicates easily with other children and adults. Says most sounds correctly except a few like l, s, r, v, z, j, ch, sh, th. Says rhyming words. Names some letters and numbers. Uses the same grammar as the rest of the family.

Communication Tips

Talk naturally to your child and use a lot of different words. Talk about what your child is doing and what your child sees.
Take time to listen to your child. Respond to what is said so your child knows you have been listening.
Read to your child often and start early.
Accept some speech mistakes as your child develops. Don't ask your child to slow down or repeat.
Have your child's hearing tested if you find you have to repeat a lot or have to talk loudly to get your child's attention.
Seek professional help from an ASHA-certified audiologist or ASHA-certified speech-language pathologist if you're concerned about your child's communication development. Don't wait to get help for your child if you suspect a problem. You and your family members know more about your child than anyone else.
Early identification and treatment of hearing, speech, and language disorders can prevent problems with behavior, learning, reading, and social interactions.
If your child is being raised in a bilingual home, use vocabulary from both languages in everyday interactions.
Refer to Beyond Baby Talk by Apel and Masterson and Talking on the Go by Dougherty and Paul for more communication tips to stimulate good speech and language skills.

Phonemic awareness refers to the specific ability to focus on and manipulate individual sounds (phonemes) in spoken words. Phonemes are the smallest units comprising spoken language. Phonemes combine to form syllables and words. The word mat, for example, has three phonemes, /m/ /a/ /t/. There are 44 phonemes in the English language, including sounds represented by letter combinations such as /th/. Acquiring phonemic awareness is important because it is the foundation for spelling and word recognition skills. Phonemic awareness is one of the best predictors of how well children will learn to read during the first two years of school instruction.

Students at risk for reading difficulty often have lower levels of phonological awareness and phonemic awareness than do their classmates. The good news is that phonemic awareness and phonological awareness can be developed through a number of activities. Read below for more information.

What the problem looks like

A kid's perspective: What this feels like to me

Children will usually express their frustration and difficulties in a general way, with statements like "I hate reading!" or "This is stupid!". But if they could, this is how kids might describe how difficulties with phonological or phonemic awareness affect their reading:

I don't know any words that rhyme with cat.
What do you mean when you say, "What sounds are in the word brush?"
I'm not sure how many syllables are in my name.
I don't know what sounds are the same in bit and hit.

Click here to find out what kids can do to help themselves.

A parent's perspective: What I see at home

Here are some clues for parents that a child may have problems with phonological or phonemic awareness:

She has difficulty thinking of rhyming words for a simple word like cat (such as rat or bat).
She doesn't show interest in language play, word games, or rhyming.

Click here to find out what parents can do to help a child at home.

A teacher's perspective: What I see in the classroom

Here are some clues for teachers that a student may have problems with phonological or phonemic awareness:

She doesn't correctly complete blending activities; for example, put together sounds /k/ /i/ /ck/ to make the word kick.
He doesn't correctly complete phoneme substitution activities; for example, change the /m/ in mate to /cr/ in order to make crate.
He has a hard time telling how many syllables there are in the word paper.
He has difficulty with rhyming, syllabication, or spelling a new word by its sound.

Click here to find out what teachers can do to help a student at school.

How to help

With the help of parents and teachers, kids can learn strategies to cope with phonological and/or phonemic awareness problems that affect his or her reading. Below are some tips and specific things to do.

What kids can do to help themselves

Be willing to play word and sounds games with parents or teachers.
Be patient with learning new information related to words and sounds. Giving the ears a workout is difficult!
Practice hearing the individual sounds in words. It may help to use a plastic chip as a counter for each sound you hear in a word.
Be willing to practice writing. This will give you a chance to match sounds with letters.

What parents can do to help at home

Check with your child's teacher or principal to make sure the school's reading program teaches phonological, phonemic awareness, and phonics skills.
If your child is past the ages at which phonemic awareness and phonological skills are taught class-wide (usually kindergarten to first or second grade), make sure he or she is receiving one-on-one or small group instruction in these skills.
Do activities to help your child build sound skills (make sure they are short and fun; avoid allowing your child to get frustrated):
- Help your child think of a number of words that start with the /m/ or /ch/ sound, or other beginning sounds.
- Make up silly sentences with words that begin with the same sound, such as "Nobody was nice to Nancy's neighbor".
- Play simple rhyming or blending games with your child, such as taking turns coming up with words that rhyme (go – no) or blending simple words (/d/, /o/, /g/ = dog).
Read books with rhymes. Teach your child rhymes, short poems, and songs.
Practice the alphabet by pointing out letters wherever you see them and by reading alphabet books.
Consider using computer software that focuses on developing phonological and phonemic awareness skills. Many of these programs use colorful graphics and animation that keep young children engaged and motivated.

What teachers can do to help at school

Learn all about phonemes (there are more than 40 speech sounds that may not be obvious to fluent readers and speakers).
Make sure the school's reading program and other materials include skill-building in phonemes, especially in kindergarten and first grade (these skills do not come naturally, but must be taught).
If children are past the age at which phonemic awareness and phonological skill-building are addressed (typically kindergarten through first or second grade), attend to these skills one-on-one or in a small group. Ask your school's reading specialist for help finding a research-based supplemental or intervention program for students in need.
Identify the precise phoneme awareness task on which you wish to focus and select developmentally appropriate activities for engaging children in the task. Activities should be fun and exciting – play with sounds, don't drill them.
Make sure your school's reading program and other materials include systematic instruction in phonics.
Consider teaching phonological and phonemic skills in small groups since students will likely be at different levels of expertise. Remember that some students may need more reinforcement or instruction if they are past the grades at which phonics is addressed by a reading program (first through third grade).

More information

Find out more about phonological and phonemic awareness with these resources from Reading Rockets, The Access Center, and LD OnLine:

Difference Between Hearing Screening and Hearing Evaluation

The difference between hearing screening and hearing evaluation can sometimes be confusing. A hearing screening is usually a preliminary step in which an individual’s hearing is checked to see if further evaluation is required.

In other words, hearing screening is a quick and cost-effective way to separate people into two groups: a pass group and a fail group. Those who pass hearing screenings are presumed to have no hearing loss. Those who fail are in need of more detailed hearing evaluation by a qualified audiologist.

It is recommended that all hearing screening programs be conducted under the supervision of an audiologist holding the ASHA Certificate of Clinical Competence (CCC).

A hearing evaluation is an in-depth assessment of an individual’s hearing by an audiologist. The purpose of this evaluation is to determine the nature and degree of the hearing loss and the best treatment options. Audiologists use a number of different tests in this evaluation.