Introduction

Definition of articulation disorders

Many children develop speech sounds by the age of four to five; however, when a child has trouble speaking in that age range, it may indicate that they have a speech disorder. One type of speech disorder is called an articulation disorder (AD), which is when an individual has trouble expressing themselves verbally.¹ 

An AD can impact each individual differently. An example of this is a child with an inability to make certain sounds and who may form words incorrectly. In contrast, another child’s speech may be hard to understand, which in turn may affect socialising and learning. 

People with an AD tend to have difficulty using their motor skills to help them make a certain sound or words. They are unable to coordinate their lips, tongue, teeth, roof of their mouth and lungs to make certain sounds. As a result, they may make distorted speech sounds or switch sounds they can’t produce. An example of this would be instead of using the sound “th”, they always use the sound “f” or replace “r” with “w”.¹

Although the cause of speech and sound disorders is unknown, they are quite common. They affect 8 to 9% of children, more commonly impacting boys than girls.¹

Importance of speech therapy

Speech therapy is an amazing intervention to aid individuals who have AD to progress in communicating effectively. The goals of the therapy usually include improving pronunciation, strengthening the muscles used in speech, and learning to speak correctly.²

More benefits include:

• Improved self-esteem
• Increased independence
• School readiness for young children
• Improved ability to comprehend and express ideas, thoughts and feelings
• Improved quality of life³

Causes of articulation disorders

In general, there is no identifiable cause for the development of AD; however, some factors may contribute to an individual's development of AD.

Developmental delays can be a factor causing articulation disorders in children. When it comes to speech development, sensory and motor experiences are the foundation of it. However, some children who have reduced functions in vestibular, proprioceptive and tactile sensory systems are more likely to have a speech disorder in comparison to children with normal development. When a child has a defect in their sensory system, for example, auditory, perception or vestibular system, speech development will be affected, thus, causing delays in speech development and articulation disorders.⁴

Another factor is having mild to moderate permanent bilateral hearing loss. With cases of mild hearing loss, the most difficult speech sounds to detect are usually with higher frequencies, ranging from 2000 to 4000Hz and lower intensity, ranging from 20 to 30 dB. Pronunciations such as “s”, ”f” and “th”, are placed into the high-frequency sounds category and are among the last sounds to emerge in developing children. Since high-frequency hearing loss may be more common than low-frequency hearing loss, children with mild hearing loss are most likely to struggle to understand and make these sounds correctly.⁵

In adults, articulation disorders are usually induced by neurological disorders, traumatic brain injuries and strokes. These conditions can cause dysarthria, which is a serious condition that makes it hard to move the muscles inside the mouth, face or upper respiratory system. As a result, it affects your ability to speak. These can often coexist with other conditions such as stuttering, ADHD and language impairments.^6,7

Another factor is having a structural disorder. This is when a child finds it difficult to make certain sounds correctly due to oral or facial structure conditions. This includes having a cleft lip/palate, overbite or underbite and tongue overgrowth condition.⁸

Common types of articulation errors

Articulation disorders involve non-typical production of speech through articulation errors such as substitutions, omissions, additions and distortion of sounds.¹

Substitutions are when someone with an articulation disorder replaces one sound with another. An example of this is by using “s” instead of “th” or “w” in place of “r”.¹

Omission is leaving out certain sounds from their speech completely. For instance, by never using “sc” in “school” or “scratch”.¹

Distortion is another articulation disorder error where the individual changes a sound. Sometimes it might sound like a lisp at first listen. For example, when using “s” and it sounds like a “th”.¹

Additions occur when an individual adds sounds and syllables to words that do not belong there. Occasionally, it may sound like an exaggeration of a specific sound, for example, a person saying “puh-lay” instead of “play”.¹

Speech therapy: assessment process

Speech therapy typically begins with an assessment. This is done by a Speech-Language Pathologist (SLP), who will find the best way to treat an articulation disorder.¹⁰

During the assessment process, you and your child will undergo an interview. This is to gather information to assess the extent of the articulation disorder. This includes question topics such as:

• The family’s concerns about the child’s speech, language and literacy skills
• Any history of middle ear infections
• Family history of speech and language difficulties
• The language and dialect spoken at home
• The primary language and dialect spoken by the child⁸

A speech and sound assessment utilises both standardised assessment instruments and other sampling procedures to evaluate how a person produces single words and connected speech.

Single-word testing requires specific words to be produced in order to assess specific speech sounds in phonetic contexts. This provides the SLP identifiers for analysis. Single-word testing may or may not accurately reflect how the individual talks in connected everyday speech.⁸

Connected speech sampling is used by gathering everyday speech patterns from natural contexts, such as storytelling, describing pictures and normal conversations about a topic of interest. This technique shows how the child uses speech during real-life conversations and reveals errors or patterns that may not come up when using single-word testing tasks.⁸

A hearing screening is used during a speech and sound assessment if one is not done during the screening. What you can expect when going for a hearing screening includes:

• Using an otoscope to inspect the ear canal and tympanic membrane (eardrum)
• Pure tone audiometry
• Immittance testing to assess middle ear function⁸

Your child may undergo an oral mechanism exam, where the goal is to evaluate the structure and function of the physical speech mechanism (the mouth, voice box, and nasal passages) to see if the system is capable of producing speech.⁸

Speech therapy: Interventions

In speech and language therapy, an SLP works with children either one-to-one, in a small group or in a classroom.¹⁰ SLPs use a variety of strategies, such as:

• Language intervention activities, which are conducted by an SLP who will engage in play and conversation with a child, utilising pictures, books, objects or events to stimulate language development. Often, repetition exercises are used to improve language skills¹⁰
• Articulation therapy, which includes the SLP modelling correct sounds and syllables in sentences for a child during play activities, whilst aligning to their specific needs. The SLP will teach the child how to make certain sounds and how to move the tongue correctly when talking¹⁰
• Oral motor/feeding and swallowing therapy, which is when the SLP will use a variety of oral exercises to strengthen the muscles of the mouth. This is typically used for children with feeding and swallowing disorders. Different food textures are also introduced to increase a child’s oral awareness¹⁰

Expected outcomes and progress

To provide better outcomes for a child with AD, it is important to scope out indications promptly during the early stage of providing interventions. It is beneficial to identify indications of articulation disorders within a child’s first five years, as during this period, a child’s brain develops the most and is able to grasp new things quickly and build a foundation for learning.^11,13

It is vital for parents and families to remember that progress needs consistency. Research highlights that speech therapy requires consistency, similar to any motor skill that requires practice. It may require at least fifty consistent sessions to see a significant change. Children who go to more sessions show greater improvement in their articulation skills in comparison to those who receive low-intensity support.^14,15

Additionally, it is worth noting that although treatment is essential for articulation disorders, it is more effective towards less severe disorders. Children who are on the severe end can still develop and enhance their communication skills, which improves their quality of life even if it may not be completely resolved.¹⁶

Parental involvement is essential for successful speech therapy. When parents get involved with their child during daily activities such as mealtime and play, their child’s progress improves. Incorporating positivity as well as demonstration also improves a child’s speech development and encourages continuous foundational learning.¹⁷

Summary

To sum up, articulation disorders are when a person develops an inability to articulate themselves. Although the causes may vary, such as hearing loss, developmental delays, structural or even neurological, the effects without intervention come down to being very similar to one another.^1-8 

It is important that speech therapy is put in place during a child’s first five years, as it is when the brain develops the most.^11,13 It is crucial to remember as a parent or family member that progress takes time. Being involved makes a big difference in supporting skills outside of therapy sessions, both improving independence and daily function. When putting this together with an SLP’s support, people with an AD will be able to improve their speech efficiently and become more confident in articulating themselves.^16,17