As speech-language pathologists, we sit with worried parents every single week. The questions sound familiar: Is this a phase? Should we already be doing something? Here's what we want you to know first: feeling unsure means you're paying attention.
Speech disorders in children are more common than many families realize, and they can show up in different ways. Sometimes it's a sound that never quite lands right. Sometimes it's a pattern of sound errors. Sometimes it's difficulty with the movements needed for speech, fluency, or voice. Understanding what's going on is the first step toward helping your child communicate more effectively.
What this article covers:
- What Is a Speech Disorder?
- Common Types of Speech Disorders in Children
- Causes of Speech Disorders in Children
- Why Is Early Diagnosis and Intervention Important?
- Sources
What Is a Speech Disorder?
A speech disorder affects a child's ability to produce or use speech sounds, speak fluently, or use their voice in an expected way.
It's different from a language disorder, which affects a child's ability to understand and/or use words, sentences, and ideas to communicate. Speech and language disorders can also occur together.
Because different speech disorders can sometimes look or sound similar, identifying what is actually happening is important. An accurate diagnosis helps guide the plan for therapy.
Common Types of Speech Disorders in Children
No two speech disorders look quite the same, and that's exactly why an accurate diagnosis matters so much. Here's a rundown of the ones we see most often in our work with kids:
1. Articulation Disorders
An articulation disorder involves difficulty producing individual speech sounds accurately. For example, a child might substitute “w” for “r.”
Some speech sound errors are expected during development, and children acquire different sounds at different ages. A speech-language pathologist considers a child's age, linguistic background, overall intelligibility, stimulability, and pattern of errors when determining whether speech development is typical or whether intervention may be appropriate.
2. Phonological Disorders
Phonological disorders can look similar to articulation disorders, but instead of involving only the production of an individual sound, they involve patterns in the way a child organizes and uses sounds in words.
A child might say “boo” for “book” or “pi” for “pig,” dropping the final consonant across many different words. This is an example of a phonological pattern called final consonant deletion.
The distinction between articulation and phonological disorders isn't always perfectly clear. Some children demonstrate both articulation and phonological difficulties, which is one reason a comprehensive speech assessment is so important.
3. Childhood Apraxia of Speech
Childhood apraxia of speech, or CAS, is one we work with constantly, and it's often misunderstood.
CAS is a motor speech disorder involving difficulty planning and programming the precise movements needed for speech. It is not caused by muscle weakness or a lack of intelligence.
A child with CAS may know what they want to communicate but have difficulty consistently planning and sequencing the movements needed to produce speech accurately.
Three characteristics have received research consensus as being associated with CAS:
- inconsistent errors on consonants and vowels across repeated productions of syllables or words;
- lengthened or disrupted transitions between sounds and syllables; and
- inappropriate prosody, particularly differences in lexical or phrasal stress.
These characteristics are important, but CAS cannot be diagnosed using a simple checklist. There is no single characteristic or test that, by itself, confirms a diagnosis of CAS. A comprehensive motor speech evaluation and careful differential diagnosis are important.
CAS is not something children simply “grow out of.” Children with CAS benefit from appropriate speech therapy that addresses their individual motor speech needs.
4. Dysarthria
Dysarthria is another motor speech disorder, but it is different from childhood apraxia of speech.
While CAS primarily involves difficulty with the planning and programming of speech movements, dysarthria involves difficulty executing speech movements because of impairment within the neuromuscular system.
Depending on the type and severity of dysarthria, speech may sound slurred, slow, quiet, strained, breathy, or otherwise different. A child may demonstrate differences in articulation, respiration, phonation, resonance, rate, or prosody.
Treatment is individualized based on the child's specific speech characteristics and communication needs and may address areas such as respiration, phonation, articulation, resonance, prosody, intelligibility, and functional communication.
CAS and dysarthria can share some speech characteristics, and some children may demonstrate features of both. That's why careful differential diagnosis is so important.
5. Stuttering (Fluency Disorders)
Stuttering interrupts the natural flow and timing of speech through behaviors such as repeated sounds or syllables, prolonged sounds, or blocks.
Some disfluency is normal while young children are developing speech and language. An evaluation may be appropriate when stuttering persists or increases, includes visible tension or struggle, causes frustration or avoidance, or concerns the child or family.
There isn't one specific age at which every child who stutters should begin therapy. An SLP considers factors such as the type and frequency of stuttering, how long it has been occurring, family history, physical tension, the child's reactions to speaking, and the impact on communication.
Stuttering is not caused by anxiety, parenting style, or emotional problems, although emotions and communication situations can influence how a person experiences stuttering.
6. Voice Disorders
A voice disorder changes the pitch, volume, quality, or resonance of a child's voice, often making it sound hoarse, breathy, raspy, strained, or otherwise different.
Some children develop voice disorders related to patterns of voice use, such as frequent yelling, while others may have structural, neurological, or medical factors affecting the voice.
A voice that consistently sounds different or remains hoarse for an extended period of time is worth a second look from a professional. Depending on the concern, evaluation may involve both a speech-language pathologist and a physician specializing in the ear, nose, and throat.
Causes of Speech Disorders in Children
There's rarely a single cause behind a speech disorder, and in many cases, no exact cause is identified. Causes and contributing factors also vary depending on the type of speech disorder.
Some factors associated with speech disorders in children may include:
- Hearing loss or hearing difficulties that interfere with access to speech sounds
- Neurological or neuromuscular conditions affecting speech
- Structural differences such as cleft palate or other differences involving the speech mechanism
- Genetic factors or a family history of speech and language difficulties
- Developmental conditions, including autism spectrum disorder
- Differences in speech motor planning or execution
- Overuse or misuse of the voice, such as chronic yelling or screaming, in some voice disorders
It's important to remember that these factors do not all cause every type of speech disorder. Many children with speech sound disorders have no identifiable cause.
A cause isn't required to start treatment, and effective therapy targets the skills your child needs to build, not just the reason behind the difficulty.
Why Is Early Diagnosis and Intervention Important?
Early diagnosis and intervention can help children access appropriate support sooner and reduce the amount of time they spend struggling to communicate.
Families are sometimes told to “wait and see” when they have concerns about a child's speech. But you don't have to know whether something is definitely a disorder before asking for help.
A speech-language pathologist can evaluate a child's speech development, determine whether speech patterns are expected for the child's age and linguistic background, and identify whether monitoring, additional assessment, or intervention is appropriate.
Don't wait—evaluate.
If your gut tells you something is off, trust it enough to get a professional opinion. An evaluation doesn't automatically mean your child needs therapy. It gives you information so you can make an informed decision about what comes next.
Support at home can also look different than you might expect. Although the issue might be speech-related, speech and literacy development are connected. Some children with speech sound disorders—particularly children who also have phonological awareness or language difficulties—may be at increased risk for difficulties with reading, spelling, and written language.
Learning how to help a child struggling with reading and helping kids with reading comprehension can set them up for success later. Understanding how spoken sounds connect to letters and words is an important part of literacy development.
The importance of reading to children and the benefits of reading to children are huge. Reading together creates opportunities to build vocabulary, language, sound awareness, comprehension, and positive experiences with books.
Conclusion
Every child's speech story unfolds on its own timeline, and that's part of what makes this work so meaningful to us. Some children need a short period of targeted therapy. Others need years of ongoing support. And some speech differences are part of typical development and don't require therapy at all.
When you're concerned about your child's speech, you don't have to guess whether they'll grow out of it. An evaluation by a speech-language pathologist can help distinguish typical development from a speech disorder and determine whether treatment is needed.
We built our speech therapy tools, designed by speech-language pathologists, to give families and clinicians resources for supporting speech, language, and literacy development while keeping learning engaging and play-based.
If you're worried about your child's speech, talk with your pediatrician or contact a speech-language pathologist for an evaluation.
Sources
American Speech-Language-Hearing Association. (n.d.). Childhood apraxia of speech. ASHA Practice Portal.
https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/
American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonology. ASHA Practice Portal.
https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/
American Speech-Language-Hearing Association. (n.d.). Stuttering, cluttering, and fluency. ASHA Practice Portal.
https://www.asha.org/practice-portal/clinical-topics/fluency-disorders/
American Speech-Language-Hearing Association. (n.d.). Voice disorders. ASHA Practice Portal.
https://www.asha.org/practice-portal/clinical-topics/voice-disorders/
Iuzzini-Seigel, J., Allison, K. M., & Stoeckel, R. (2022). A tool for differential diagnosis of childhood apraxia of speech and dysarthria in children: A tutorial. Language, Speech, and Hearing Services in Schools, 53(4), 926–946. https://doi.org/10.1044/2022_LSHSS-21-00164
