Speech Disorders

Many young children have difficulty with communication at some time in their lives. While most children will eventually catch up, some will continue to have problems. Communication disorders include speech disorders and language disorders. Speech disorders are discussed in this article and some general guidelines are also given.  This will help you decide if your child needs to be tested by a speech-language pathologist.

A child with a speech disorder may have difficulty with articulation, voice, resonance or fluency. 

Articulation involves the physical production of speech sounds. A child with a speech sound disorder will have difficulty articulating certain speech sounds. This can make the child hard to understand.

Types of Speech Sound Errors

  • Omissions: A child may leave out sounds in words and sentences. For example: "I go to coo on the buh" (I go to school on the bus); or "I ree a boo" (I read a book).
  • Substitutions: A child may use an incorrect sound instead of the correct one. For example: "Wook a the wittle wamb" (Look at the little lamb); "I tee the tun in the ty (I see the sun in the sky)"; "I like tooties and tate" (I like cookies and cake).
  • Distortions: A child tries to make the right sound, but cannot produce it clearly. For example, the /s/ sound may whistle, or the air may come out the sides of the mouth, making a "slushy" sound (“lateral lisp”); or, the tongue may push between the teeth causing a “frontal lisp.”


For most children, the cause of the speech sound disorder in unknown. Other speech sound disorders can be linked to things such as a cleft palate, problems with the teeth, hearing loss, or difficulty controlling the movements of the mouth.

  • Oral Apraxia: The child may have difficulty making voluntary movements of the tongue and lips, and will have trouble combining these movements needed to make speech sounds. As a result, a child’s speech may be difficult to produce and there are often many inconsistent articulation errors in connected speech.
  • Dysarthria: The child my show paralysis, weakness, or generally poor coordination of the muscles of the mouth. This can make speech slow, inaccurate, slurred, and/or hypernasal (when too much sound comes through the nose).

Reasons for Concern  

  • If the child doesn't babble using consonant sounds (particularly b, d, m, and n) by age 8 or 9 months
  • If the child does not produce one word other than mama or dada by 12 months
  • If the child uses mostly vowel sounds and gestures for communication after 18 months
  • If the child’s speech cannot be understood by strangers at the age of 3
  • If the child often leaves out consonant sounds from words at the age of 3
  • If the child’s speech is still difficult to understand at the age of 4
  • If  the child is still not able to produce most speech sounds by the age of 6
  • If the child is distorting sounds such as /s/ and /r/ after the age of 6 or 7
  • If the child is embarrassed or worried about his speech at any age 

    The voice is produced as air from the lungs moves up through and vibrates the vocal cords. This is called phonation. The voice is then changed as it travels up through the different-shaped spaces of the throat, nose, and mouth. This is called resonance. Voice disorders include both phonation and resonance disorders:

    Phonation Disorders

    The voice may be harsh, hoarse, raspy, cut in and out, or show sudden changes in pitch with phonation disorders. Voice disorders can be due to vocal nodules, papillomas, ulceration, a laryngeal web, paralysis or weakness of the vocal cords, and difficulty timing breathing for speech.

    Resonance Disorders 

    Resonance disorders are caused by an imbalance in sound energy as the voice passes through the spaces of the throat, nose, or mouth. When parents report that their child’s voice sounds “nasal” they are usually hearing one of two different types of resonance disorder:  

    • Hyponasality (or denasality): Hyponasality is when not enough voice energy comes through the nose, making the child sound “stopped up.” This might be caused by blockage in the nose, a structural issue, a foreign object, a cold or allergies.  
    • Hypernasality: Hypernasality happens when the movable, soft part of the palate (the velum) does not completely close off the nose from the back of the throat during speech. When this happens, too much sound energy escapes through the nose. This can be due to a history of cleft palate, a submucous cleft, a short palate, a wide nasopharynx, the removal of too much tissue during an adenoidectomy, or poor movement of the soft palate. 

    Reasons for Concern  

    • If the voice is hoarse, harsh, breathy, or of poor quality
    • If the voice is always too loud or too soft
    • If the voice is too high or too low for the child's age or sex
    • If the voice often breaks or suddenly changes pitch
    • If the voice sounds hyponasal or hypernasal

    Fluency is the natural “flow” or forward movement of speech. A fluency disorder, or stuttering, is when speech shows an abnormal number of repetitions, hesitations, prolongations, or disturbances in this rhythm or flow. Tension may also be seen in the face, neck, shoulders, or fists. There are many theories about why children stutter.  Most experts agree that certain environmental reactions to normal disfluencies can result in stuttering.

    Reasons for Concern

    • When the child’s speech seems to have many repetitions, hesitations, prolongations, blocks, or disruptions
    • If the child appears tense during speech
    • If the child avoids speaking due to a fear of stuttering
    • If the child considers himself to be someone who stutters

    Early intervention is very important for children with communication disorders. Treatment is the most effective the earlier it is started. Early toddler and preschool years are a critical period of normal language learning, and strong speech habits have not yet been formed.

    The early skills needed for normal speech and language development can be tested even in infants. At that age, the speech-language pathologist works with the parents on stimulating speech and language development in the home. Active treatment in the form of individual therapy is usually begun between the ages of 2 and 4.

    If there is a concern about the child’s communication skills at any age, this should first be discussed with the child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment. 

    Children learn speech and language skills by listening to the speech of others, and practicing as they talk to others. Parents are the most important teachers for their child in the early years. 

    They can help the child by giving lots of opportunities to listen to speech and to talk. This can be done by frequently pointing out and naming important people, places, and things. Parents can also read to the child and talk to the child throughout the day, especially during daily routines and favorite activities. Parents can give the child models of words and sentences to repeat.

    Parents can also set up opportunities for the child to answer questions and talk. Listening to music, singing songs, and sharing nursery rhymes and finger plays are also great ways to build speech and language while having fun with your child.

    For more information, contact the Division of Speech-Language Pathology, 513-636-4341.

    Last Updated 02/2016