Speech sound disorders (SSD) are complex conditions which affect the ability to communicate. They range from saying sounds
incorrectly to being completely unable to speak or understand speech. A speech sound disorder is an impairment of voice,
articulation of speech sounds, and/or fluency. These deficiencies are seen in communication and use of oral coordination.

Speech sound disorders may be separated into two primary groups,
articulation disorders (also called phonetic disorders)
problems with making sounds in alphabet, and phonological disorders (also called phonemic disorders) problems with distinctive
sounds in spoken language. Speech sound disorders are speech disorders in which some speech sounds (phonemes) are either not
produced, not produced correctly, or are mispronounced. However, some children may have a mixed disorder in which both
articulation and phonological difficulties exist. Though speech sound disorders are associated with childhood, some effects may
continue into adulthood.

Children with SSD’s make up for approximately 15% of children referred to speech and language therapy, usually at 3 years of
age. It is likely that these children represent a diverse group, excluding children with disorders such as pervasive developmental
delay, and other neurological developmental disorders.

Characteristics found in SSD:

•        
Omissions: Certain sounds are not produced entire syllables or specific sounds may be deleted.
•        
Additions: An extra sound or sounds are added to the intended word.
•        
Distortions: Sounds are changed slightly so that the intended sound may be recognized but sound inaccurate or may sound
like any sound in the speaker’s fluent language. The best known example of distortion is a lisp.
•        
Substitutions: One or more sounds are substituted for another; e.g. twee instead of the tree.

Some distorted forms of /r/ 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 recognize which
word was actually intended.

The causes or origin of children with early speech sound disorders are unknown. The search for genetic influences is difficult and
has not been research thoroughly. It is likely that SSDs have more than a single set of causes that contribute to the incidence of
the disorder.

Phonological Disorders and Articulation Disorders         

Both phonology and articulation refer to the structure of forming the individual sounds in speech.  They do not relate to producing
or understanding the meaning or content of speech. A child with either a phonological disorder or an articulation disorder is often
difficult to understand.

The child incorrectly makes group of sounds, usually substituting earlier developing sounds for later-developing sounds and
consistently omitting sounds. Children with phonological deficits often substitute t/k and d/g. They frequently leave out the letter s
so stamp becomes tamp and snake, nake. Phonological deficits usually seriously affect fluency. Sounds may be well articulated,
but inappropriate for the context.

Diagnosis is normally made between 2 and 4 years of age. In terms of their sound structure, children with phonological disorders
produce, on average, 8 of the 24 letters in the English language. Most children respond well to intervention, which can take
several years. There is extensive research relating to phonological disorders and difficulty with learning to read. Early intervention
is important with these children. The cause is most frequently linked to temporary hearing loss due to colds, ear infections, and
allergies.

Children with severe phonological disorders present a particular medical and academic challenge. Their accumulation of language
might include nasals, stops and glides, but not at all places of verbalization and difficulty with speech sounds produced, due to
breath moving against a narrowing of the vocal tract. Some children also have poor or errors in vowel capacity. Most notably,
however, these disadvantages on the sound system come in the absence of any other obvious deficits. These children’s prenatal
and developmental histories are typical; they have normal hearing and intelligence; other areas of the linguistic system are intact;
and they do not commonly appear to have perceptual, processing, or oral-motor deficiencies.

Possible Causes of Phonological Disorders

There is no known cause of phonological disorders in children. Primary and rising evidence points to possible genetic origins for a
limited number of children.
Still others have identified risk factors that increase the probability for developing the disorder as based on male gender, an
affected sibling, and low maternal education. Aside from these observations, little is else known about the underlying cause of
phonological disorders.

An important detail known is that there is a critical period for speech sound normalization. The most favorable window of time in
which to modify a child’s sound system with the target language is between the ages of 4 and 6. Moreover, beyond age 8.5, there
are level in learning, which limits the amount and degree of change in adjustment. These, in turn, can further impact children’s
ability to read, write, and perform academically. As a result, while there is no known cause, there is a critical and early need for
clinical treatment of phonological disorders. In particular, linguistic qualities of sound systems can be used to enhance
phonological learning in treatment.

Treatment Approaches for Phonological Disorders

Minimal pairs
- This approach can be used with children with moderate to severe phonological disorders and poor speech
intelligibility. In this approach, the SLP selects words which differ by only one sound to draw the child's attention to the fact that
meanings are indicated by the difference between the chosen sounds.

Phonological cycle approach - This approach uses three key elements which include auditory overload of phonological targets at
the beginning and end of sessions, to teach formation and a series of the sound targets.

Articulation Disorders

Articulation is a general term which refers to the production of individual sounds. The production of sounds involves the
coordinated movements of the lips, tongue, teeth, palate (top of the mouth) and respiratory system (lungs). It also includes many
different nerves and muscles used for speech.

When young children are growing, they develop speech sounds in a predictable order. A child with an articulation disorder has
difficulty producing and forming particular speech sounds properly (an example 'lisp') or they may not be able to produce a
particular sound (for example the 'r' sound). These disorders are generally very specific and need therapy from a trained speech
pathologist.

An articulation disorder can co-occur with giftedness, language and learning disabilities, and retardation. The causes are varied and
may be linked to temporary hearing loss due to otitis media (frequent ear infections) or allergies; structural or functional problems
with the lips, teeth, tongue, or hard palate; or a medical condition such as cleft palate or cerebral palsy.

Articulation errors are characterized by the omission, distortion, substitution, addition and/or incorrect sequencing of speech
sounds.

Causes of articulation disorders:

•        Hearing Loss
•        History of ear infections during the first few years of life
•        Speech sound perception and ability to distinguish
•        Tooth alignment and missing teeth
•        Impaired oral-motor skills
•        Eating problems
•        Tongue thrust swallow after 6 years of age
•        Neurological disorders
•        Mental retardation
•        Language problems
•        Reading disorders
•        Family history

Articulation Assessment / Articulation Test

Formal assessment should include both articulation and phonology. A speech-language pathologist (SLP) should use caution in the
interpretation of standardized scores to determine need for service. Although some assessments will reveal standardized scores
below the average range for single sound inaccuracy, services may not be necessary if there is not a poor educational outcome.
The standardized scores should be interpreted carefully, always taking into consideration impact on educational performance.

A speech-language pathologist is the professional that evaluates children with speech and language difficulties. The SLP listens to
the child 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 trait of jargon or accent. For all children, the SLP often also evaluates their language
development to determine overall communication functioning.
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