Some children have difficulty pronouncing words for unknown reasons, also known as a speech-sound disorder. Others may struggle due to structural differences of the oral cavity or motor planning. Correction of speech-sound errors is necessary, as speech-sound disorders place children at-risk for reading [and writing] difficulties. Children with moderately disordered sound systems tend to have poor auditory, phonological, and verbal memory skills (Sies, Taylor, Freebairn, Hansen, & Lewis 2007).
Evaluation
To correct a speech-sound disorder, an evaluation is necessary. This evaluation will determine a few things:
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- Which sounds are being said in error?
- What type of error is being demonstrated?
- Are these errors appropriate for your child’s age?
- Is motor planning a concern?.
Speech-Sound Disorder or Not?
To determine if your child is demonstrating a speech-sound disorder, we look at norms. These norms are created based on gathered information about children throughout the United States, usually over many years. Several sets of norms have been created regarding the development of children’s speech sound systems, and they all vary in some way. The norms shown below are the most recently compiled. It specifies the age range where each sound is expected to be pronounced accurately.
In addition to using norms, standardized assessments, and peer reviewed data, and cultural differences, speech-language pathologists must use professional judgment in determining what is typical vs atypical behaviors specific to your child to interpret data correctly. With this information, we create realistic and achievable goals specific to your child. For example, though a child has until age 4 to produce the /s/ sound accurately, frontal and lateral lisps are due to disordered motor planning and placement and affect many sounds, including /z/, early on in the stages of communication. In these cases, correction of the disordered motor planning should be addressed as soon as possible.
Therapeutic Approach to Speech-Sound Disorders
Like other forms of development, it occurs in stages. Hierarchy in therapy is no different; we build one skill to support another. Once we’ve identified which sound(s) your child does not produce appropriately for their age, we target that sound in specific positions of words (initial, medial, final). A sample goal looks like Billie will produce final /s/ at word level with 80% accuracy within a structured activity.
The level of articulation therapy increases in verbal complexity as follows:
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- Sound in Isolation| We focus on learning the correct placement of the tongue, teeth, and lips (articulators) to improve the success rate of just producing the target sound only.
- Sound in Syllables| We pair the target sound with vowels and blend them to create real or nonsense words — this is a great phonemic awareness activity for non-readers.
- Sound in Words |We work on the target sound in specific positions of words (usually using photo cards). Segmenting or separating the target sound from the remainder of the word is expected at this stage, as your child will later be able to blend the complete word.
- Sound in Phrases| We begin to work on the target sound within short bursts of connected speech.
- Sound in Structured Sentences| We begin to work on this sound within longer bursts of connected speech while making statements or answering and asking questions.
- Sound in Conversation| At this point, the child is near mastery and the sound is addressed in structured conversations (i.e. discussions about topics of interest).
In all these instances, the speech-language pathologist employs many tools and techniques to elicit words, provide auditory feedback, visual feedback and engage the child. Additionally, parents are informed of tools they can use at home to assist in their child’s speech development.
