Articulation and Phonological Process Disorders
Speech sounds emerge at different rates, which is why some errors and difficulty understanding a
child’s speech are to be expected. Children become increasingly intelligible as they grow and
develop an increasing amount of speech sounds. Abnormal rates of speech sound acquisition or
high levels of unintelligibility may indicate an articulation or phonological process disorder.
An articulation disorder is a type of motor speech disorder. Three key factors go into the
production of speech sounds: the placement of our oral structures, the manner of airflow, and
whether or not our vocal folds move. Children with articulation disorders experience difficulty
with one or more of these when making consonant and/or vowel sounds. Articulation disorders
may be the result from various causes such as hearing loss, cleft palate, or dental abnormalities.
As children’s speech and language systems develop, they demonstrate error patterns used to
simplify adult speech sounds. Phonological process disorders are speech sound error patterns that
persist beyond what is expected at certain ages. Errors such as leaving off all final consonants
words or omitting syllables are examples of phonological process disorders.
It is important to acknowledge that speech sound differences due to cultural or ethnic
backgrounds are not considered to be disorders.
Childhood Apraxia of Speech
Childhood apraxia of speech (CAS) is a type of motor speech disorder characterized by difficulty
positioning and sequencing muscle movements for intelligible speech. CAS is not the result of
muscle weakness or paralysis, but rather it involves the brain and its role in planning the
movements required for speech sounds. Children who present with CAS may demonstrate errors
such as vowel distortions, inconsistent speech errors, difficulty producing complex words,
“groping” movements of the oral structures, and/or highly unintelligible speech.
Fluency refers to the continuity, smoothness, rate, and effort of speech production. Disruptions in
any of these result in a fluency disorder.
Stuttering, the most common fluency disorder, is an interruption in the rate and rhythm of one’s
speech. Stuttering can be characterized by any of the following behaviors:
Sound or syllable repetitions
Silent or audible blocks
Excessive use of interjections such as “umm” or “uh”
Excessive physical tension or struggle while speaking
Cluttering is another type of fluency disorder. It is perceived as a rapid and/or irregular speech
rate that results in reduced speech clarity. Cluttering can be characterized by any of the following
Irregular rate of speech
Deletion of syllables and/or word endings due to excessive coarticulation
Children may develop “secondary behaviors” or learned reactions to these disfluent behaviors.
Common secondary behaviors may include any one or combination of the following:
Distracting sounds (throat clearing, insertion of unintended sounds)
Head movements (head nodding)
Movements of the extremities (leg tapping, fist clenching)
Sound or word avoidances (word substitution, circumlocution)
Avoidance of speaking and/or social situations
Voice disorders are characterized by abnormal vocal quality, loudness, resonance, pitch, and/or
duration based on a child’s age and/or gender. These may arise from sources such as voice
misuse (excessive coughing, yelling, throat clearing), environmental factors, or
How Do I Know If My Child Needs Speech Therapy?
Does your child’s speech seem unusual for their age and/or gender? Is your child’s speech
particularly difficult to understand compared to their peers? If this is the case, we strongly
encourage you to seek a referral from your child’s pediatrician for a speech evaluation. A formal
evaluation conducted by a speech language pathologist can help determine if your child requires
skilled and intensive treatment.
Why Is Treatment Important?
Skilled treatment by a speech language pathologist helps children develop the skills needed to
express their wants, needs, and ideas with various communication partners and settings. This can
be a vital step towards preventing frustrations your child may experience due to communication
difficulties. Some speech disorders, such as childhood apraxia of speech, require skilled and
intensive treatment as children will not outgrow them on their own. Our speech language
pathologists are trained to work closely with children and their families to achieve their