Speech Disorders

Speech disorders affect the way a child pronounces certain words.

Speech disorders are different from language disorders. Children with language disorders have trouble expressing their thoughts through language, understanding language, or both. Children with speech disorders have trouble producing speech sounds.

Speech disorders commonly seen in children include:

• Articulation disorder: Incorrect placement of the tongue, lips, or teeth that distorts the sound of words. A lisp is a type of articulation disorder.
• Phonological disorder: Predictable, rule-based sound substitutions. Children with phonological impairment may replace one sound with another (for instance, “wook” instead of “look”) or delete a sound (for instance, “bo” instead of “boat” or “tuck” instead of “truck”).
• Dysarthria: A motor speech disorder caused by muscle weakness that affects the tone, strength, and coordination of the muscles used for speech.
• Childhood apraxia of speech: A motor speech disorder that affects the planning and coordination of the muscles used for speech despite adequate strength and tone.
• Fluency disorder (stuttering): A disruption in the flow of speech characterized by repetitions, prolongations, or blocks.
• Voice disorders: Unusual vocal quality, pitch, or volume due to injury, infection, vocal misuse, or growths on the vocal cords.
• Resonance disorders: A speech impairment that affects the way air and sound move through a child’s mouth and nose, giving speech a nasal quality.

The symptoms of a speech disorder depend on the type of disorder a child has but may include:

• Missing or incorrect consonant or vowel sounds
• Speech that’s harder to understand compared to that of other children of similar age
• Repeated sounds
• Hoarseness, unusually high or low pitch, or nasal-sounding speech

As children are learning how to speak, it’s not unusual for them to have some of the features described above. Often this is temporary and not a cause for concern. If your child isn’t reaching speech milestones, is falling behind other children their age, or you have concerns about your child’s speech or ability to make certain sounds, it’s a good idea to have them evaluated by a speech-language pathologist.

In many cases, children have speech disorders for no known reason. Possible causes include:

• Structural issues, for instance, cleft palate, that interfere with a child’s ability to pronounce words.
• Vocal nodules or polyps that affect the sound quality of a child’s voice.
• Hearing loss (temporary or permanent)

Speech disorders can also be caused by other conditions or injuries:

• Autism spectrum disorder
• Cerebral palsy
• Chronic ear infections
• Down syndrome
• Genetic (present at birth) conditions
• Hearing loss
• Pediatric stroke
• Traumatic brain injury

Given the number of speech disorders and their many possible causes, diagnosis sometimes requires a team of speech-language pathologists and otolaryngologists. The comprehensive speech evaluation will include parents’ and clinicians' observations, standardized testing, and diagnostic therapy.

If your child is diagnosed with a speech disorder, their treatment may begin by addressing the condition that’s interfering with their ability to clearly form words.

Most children with speech disorders receive weekly speech therapy with a home programming component to help them practice their skills. The focus of therapy will be tailored to your child’s specific condition:

• Therapy for a phonological disorder or articulation disorder aims to help children identify sounds they can’t make and practice new ways of making those sounds.
• Therapy for dysarthria aims to increase breath support, encourage precise articulation, and may include changes in the child’s environment (home and school) to improve intelligibility.
• Therapy for childhood apraxia of speech helps children establish consistent and correct movement between sounds.
• Therapy for stuttering incorporates acceptance-based strategies and techniques to promote fluency and self-advocacy skills.
• Therapy for voice disorders improves the quality and manner of voice production and coordination of respiration with phonation.
• Therapy for resonance-related disorders aims to achieve adequate oral airflow and articulatory placement for speech sounds produced incorrectly due to compensation and mislearning.

The Speech-Language Pathology Program provides diagnostic evaluation, short-term therapy, and referrals for children with speech disorders and other communication differences. Our services include:

• Evaluation to identify your child’s strengths and areas of need. After the evaluation, you will receive a comprehensive list of our recommendations for speech therapy for your child at school or in the community.
• Weekly therapy sessions for some children. Our speech-language pathologists use interactive materials to make therapy an enjoyable and engaging experience for children. For longer-term therapy, we may refer you to speech therapy services in your community.

When a child’s speech disorder is related to another condition or injury, we work hand in hand with Boston Children’s recognized experts in a wide variety of childhood conditions to provide seamless care.