What is a speech sound disorder?

Children learn to make speech sounds over time. For example, they may be able to make "b," "m," "d," and "n" sounds as early as 6 months of age. It may take them until they are 6 years old to make "r" and "l" sounds. But when children aren't able to make the sounds that are expected for their age, they may have a speech sound disorder. These are sometimes called articulation (say "ar-TIK-yoo-LAY-shun") disorders.

Children with a speech sound disorder usually know what they want to say. But they have trouble moving their mouth, lips, and tongue correctly to make the sounds that become words. This makes their speech hard to understand.

Speech problems can have many causes. These can include hearing problems, cleft palate or other problems with the mouth, or issues with the brain. Sometimes the cause isn't known.

If your child doesn't speak as expected for his or her age, it may not mean that your child has a disorder. But if your child is having trouble with speech, talk with your doctor.

What happens when your child has a speech sound disorder?

Children with speech sound disorders can be very frustrated when others don't understand them. They can also become shy about speaking.

You may hear your child make errors that other children the same age don't make. For example, your child may leave out sounds. He or she might say "cu" instead of "cup" or "poon" instead of "spoon." Or your child may use one sound instead of another sound. He or she might say "dood" instead of "good." Another mistake is leaving a syllable out of a word. An example of this is saying "tephone" for "telephone."

Children may have other speech sound problems. One of these is a lisp. With one type of lisp, the child makes a "th" sound instead of "s," "sh," "ch" and "j" sounds. Another type of lisp makes these sounds very slushy. Some children have problems making the "r" sound. For example, a child may say "teachuh" instead of "teacher" or "wabbit" instead of "rabbit."

No one expects that strangers will understand a 2-year-old child all of the time. But a 4-year-old who can't be understood most of the time may have a speech sound disorder.

How are they diagnosed?

The doctor will do a physical exam and ask questions about your child's medical history. The doctor will also ask you questions about whether your child has reached speech milestones for his or her age.

If it looks like your child has a speech problem, the doctor will refer your child to a speech-language pathologist (SLP). SLPs diagnose and treat speech and language problems. They are also called speech therapists.

Your doctor or SLP may suggest other tests to:

• Look for other conditions. For example, your child may get a hearing test to rule out hearing loss.
• Find out what speech sounds your child can say and how well he or she puts speech sounds together to form words and sentences.
• Review how your child is developing speech, language, and motor skills.
• Find out if your child is having other problems. These could include having behaviour problems or being clumsy. It could also include having trouble doing some of the common skills for your child's age, such as sucking, chewing, or swallowing.

To test your child's speech, the SLP will listen to your child talk. He or she will ask your child to say certain sounds, words, and sentences.

How are they treated?

A child's speech can often improve with treatment such as speech therapy. To help your child speak better, the speech-language pathologist (SLP) may:

• Help your child learn to make different speech sounds and combinations of sounds. This can make speech easier for your child. It can also make your child's speech more clear.
• Help your child learn sign language or use devices to communicate if needed.

Treatment works best when problems are caught early. Your child's health care team will help you decide on the best schedule for treatment.

The SLP may suggest that your child practice every day between treatment sessions. If so, the SLP will teach you how to help your child do this at home.