Childhood Speech Impairments

  • Have you ever stopped to think about how you learned to talk?
  • As you read this sentence, say it out loud and think about what your tongue and lips are doing as you are talking
  • For many children, this amazing task of learning to use speech sounds ( or phonemes) is accomplished over the preschool years with relative ease but for other children, this task is difficult
  • Children that have difficulty learning how to produce clear, intelligible speech may have one of a number of types of childhood speech impairments

How can I find out if my child's speech development is normal?

If you are concerned about your child's speech development, contact your local speech pathologist or speech therapist. He or she will conduct an assessment of your child's speech and will be able to tell you if your child's speech is appropriate for their age.

As a guideline, 50% of what most 2 year olds say should be understood by an unfamiliar listener, 75% of what most 3 year olds say should be understood by an unfamiliar listener, and 100% of what most 4 year olds say should be understood by an unfamiliar listener.

Types of Speech Impairments in Childhood

Phonological Impairments: Children with phonological impairments form a large part of most paediatric speech pathologists' caseloads.
For example, When children are 2 years old it is quite normal that they leave the last sound off the ends of words and say "ca" for "cat". By 3-3 1/2 years old, however, they should be putting sounds on the ends of words.
When children are 2 years old it is quite normal that they use sounds produced with the tip of the tongue such as /t/, for sounds produced with the back of the tongue such as /k/, for example, saying "tea" for "key". By 3-3 1/2 years, however, they should be using these sounds correctly in words.

Articulation Impairments: Articulation impairments occur when a child cannot make a particular speech sound.
This may be caused by a problem in the mouth or nose structures that are used during speech, such as a cleft palate or a severe "tongue tie", or they may be caused by an abnormality in the function of the muscles or nerves involved in the production of speech, such as cerebral palsy.
However, most articulation impairments have no known cause. A typical example would be a lisp, where the "s" sound is not said clearly, or where it is produced with the tongue between the teeth rather than behind the teeth.

Childhood apraxia of speech (dyspraxia) is another type of childhood speech disorder but is quite uncommon.
There are many reasons that a child might be very hard to understand. A child with little speech or very unintelligible speech may have childhood apraxia (CAS) or they may not. Most children who are unintelligible are NOT DYSPRAXIC and do not have CAS.
The most important diagnostic features of CAS are inconsistent and deviant speech errors with motor impairment.

  • inconsistent errors occur when a child says individual words in a different way each time he or she attempts the word
  • deviant errors occur when the errors the child makes are not explained by developmental processes and are unusual or unexpected
  • motor impairments occur when a child has trouble coordinating oral movements or has reduced oral strength

Dyspraxia may occur in children with other disabilities such as hearing impairment or Down's syndrome or it may occur on its own. No one knows why some children have dyspraxia and others do not.

Childhood apraxia of speech used to be defined as an inability to perform the very fast and skilled mouth/tongue movements for speech when there are no hearing or other perception or motor problems and other mouth/tongue movements that do not involve speech sounds, such as sucking or swallowing, are normal.

Not all children with these characteristics will necessarily be diagnosed as having CAS. Some children with CAS may seem clumsy and uncoordinated, have problems learning to read, difficulties with grammar (he/him, is/are), and problems with other purposeful mouth movements when asked to do a task such as "show me how you kiss." Some children with CAS can have problems learning to read.

The most common therapy approach is a motor skill training approach. This is a bit like "oral gymnastics" - training the mouth by practice to combine speech movements and sounds more quickly and accurately.

It is really important to have a thorough assessment by a speech pathologist who specialises in children's speech disorders to rule out other more common disorders such as stuttering, vocal nodules and phonological disorders.

Treatment for childhood speech disorders
Speech pathologists have a variety of approaches for treating speech impairments in children.

The type of approach chosen may depend upon the type of impairment a child has. For example, the treatment for a lisp may involve instructing a child on how to produce the "s" sound correctly, followed by lots of practise at producing that particular sound in words and sentences.

Treatment for a phonological impairments may involve increasing a child's awareness about how speech sounds make meaning differences in words. For example, when a child leave sounds of the ends of words and says "bow" for both "bow" and "boat", they may be taught how to produce these words more clearly in order to make a meaning difference between the words.