Health Topics

Articulation is the physical production of speech sounds. A child with an articulation disorder has difficulty producing certain speech sounds.  This can make the child hard to understand. Types of errors include:

• Omissions - Sounds in words and sentences may be completely left out. For example: "I go a coo o the buh." (I go to school on the bus.); or "I ree a boo." (I read a book.)
• Substitutions - An incorrect (usually easier) sound is used instead of the correct one. For example: "I saw a wittle wamb;" "I tee de tun in the ty;" "I have a wed wadio;" "I'm a dood dirl."
• Distortions - The child tries to make the right sound, but cannot produce it clearly. For example, an /s/ sound may whistle, or the air come out the sides of the mouth, making a "slushy" sound (a “lateral lisp”); or, the tongue may push between the teeth causing a “frontal lisp.”

Causes of articulation disorders include cleft palate, problems with the teeth, hearing loss, or difficulty controlling the movements of the mouth. Neurological disorders that can affect articulation include:

• Oral Apraxia: Difficulty making voluntary movements of the tongue and lips, or with combining movements to make speech sounds. As a result, connected speech may have many inconsistent articulation errors.
• Dysarthria: 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 uses mostly vowel sounds and gestures for communication after 18 months
• If speech is mostly unintelligible at the age of 3
• If the child often leaves out consonants from words at the age of 3
• If speech is still difficult to understand at the age of 4
• If, by 6, the child is still unable to produce many sounds
• If the child is leaving out, substituting, or distorting sounds after the age of 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, or difficulty timing breathing for speech.

• Resonance Disorders 

These 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):

This is when not enough voice energy comes through the nose, making the child sound “stopped up.” This might be caused by some blockage in the nose, or by allergies.  

• Hypernasality:

This 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. Because of this, 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 dysfluencies 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 best started during the preschool years.  These 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.