Speech sound disorder
A speech sound disorder (SSD) is a speech disorder affecting the ability to pronounce speech sounds, which includes speech articulation disorders and phonemic disorders, the latter referring to some sounds (phonemes) not being produced or used correctly. The term "protracted phonological development" is sometimes preferred when describing children's speech, to emphasize the continuing development while acknowledging the delay.
Speech sound disorder
Speech-language pathologist
Errors produced by children with speech sound disorders are typically classified into four categories:
Sometimes, even for experts, telling exactly which type has been made is not obvious — some distorted forms of /ɹ/ may be mistaken for /w/ by a casual observer, yet may not actually be either sound but somewhere in between. Further, children with severe speech sound disorders may be difficult to understand, making it hard to tell what word was actually intended and thus what is actually wrong with it. Some terms can be used to describe more than one of the above categories, such as lisp, which is often the replacement of /s/ with /θ/ (a substitution), but can be a distortion, producing /s/ just behind the teeth resulting in a sound somewhere between /s/ and /θ/.
There are three different levels of classification when determining the magnitude and type of an error that is produced:
Note that omissions do not mean the sound cannot be produced, and some sounds may be produced more easily or frequently when appearing with certain other sounds: someone might be able to say "s" and "t" separately, but not "st," or may be able to produce a sound at the beginning of a word but not at the end. The magnitude of the problem will often vary between different sounds from the same speaker.
Most speech sound disorders occur without a known cause. A child may not learn how to produce sounds correctly or may not learn the rules of speech sounds on their own. These children may have a problem with speech development, which does not always mean that they will simply outgrow it by themselves. Many children do develop speech sounds over time but those who do not often need the services of a Speech-Language Pathologist to learn correct speech sounds.
Some speech sound errors can result from other syndromes or disorders such as:
Diagnosis[edit]
According to the DSM-5, about 50% of speech from a typical 2-year-old child may be intelligible. A 4-year-old child's speech should be intelligible overall, and a 7-year-old should be able to clearly produce most words consistent with community norms for their age. Misarticulation of certain difficult sounds ([l], [ɹ],
[s], [z], [θ], [ð], [t͡ʃ], [d͡ʒ], and [ʒ]) may be normal up to 8 years. Children with speech sound disorder have pronunciation difficulties inappropriate for their age, and the difficulties are not caused by hearing problems, congenital deformities, motor disorders or selective mutism.[7]
The DSM-5 diagnostic criteria for speech sound disorder require a persistent difficulty with speech sound production since an early developmental age. For diagnosis, this must lead to difficulty in effective communication and tangible negative social outcomes like reduced academic or occupational performance. Diagnosis is ruled out if the underlying cause is a birth defect or acquired condition such as cerebral palsy, cleft palate, deafness or hearing loss and traumatic brain injury. Other speech disorders can be diagnosed along with speech sound disorder, although differential diagnosis with selective mutism can be difficult due to normal speech being observed only in some settings.[7]
Treatment[edit]
For most children, the disorder is not lifelong and speech difficulties improve with time and speech-language treatment. Prognosis is poorer for children who also have a language disorder, as that may be indicative of a learning disorder.[7]