Speech-Sound Disorders
Rebecca McCauley
I. Description of the problem. Speech-sound system disorders consist of a delay or difference in speech-sound acquisition, resulting in speech that is difficult to understand or that sounds immature. Many children with these disorders are at risk for social-emotional and learning difficulties because of their poor speech or because of associated oral and written language problems. Historically, these disorders were referred to as articulation or phonological disorders. When severe, these disorders may be identified as “developmental apraxia of speech,” “developmental verbal dyspraxia,” or most recently “childhood apraxia of speech.”
A. Epidemiology. Speech-sound disorders have a prevalence of 5% in the school-aged population and 10% in younger children, making them one of the most frequently identified communication disorders.
Increased risk in boys.
Increased risk in children with cognitive impairment.
A significant number of children with a history of unintelligibility will experience academic difficulties through high school. Some will have negative academic and job prospects thereafter, especially those who also have identified oral and written language problems.
Whereas almost all children will outgrow the speech differences characteristic of this disorder by adolescence, its academic and social-emotional consequences nonetheless make identification and treatment an important goal. In addition, a small number of these children will exhibit distortion errors that will affect their speech into adulthood.
B. Familial transmission/genetics. A genetic basis for severe forms of speech-sound disorder (especially childhood apraxia of speech) has recently been suggested. Family histories of children with this disorder are often positive for other speech and language disorders and for written language problems.
C. Etiology/contributing factors.
1. Organic. Early recurrent periods of otitis media with effusion are an important risk factor in about one-third of children with speech-sound disorders. There is little evidence that an abnormally short lingual frenulum (“tongue-tied”) affects articulation and ambiguous evidence for the role of infantile swallow (tongue thrust) in the disorder. Childhood apraxia of speech is now seen as occurring in three contexts: idiopathically, as a result of known neurologic impairment, or as part of a complex neurobehavioral disorder of known or unknown etiology (e.g., Down syndrome, autism spectrum disorder).
2. Developmental. Diagnosis before age 3 is difficult because young children are highly variable in their speech-sound productions and in their cooperation with structured tasks. However, infrequent vocalizations or feeding or swallowing problems may indicate oromotor problems that can predispose the child to speech-sound disorders.
II. Making the diagnosis.
A. Signs and symptoms. (See Table 76-1.)
B. Differential diagnosis. Conditions resulting in delayed speech-sound development include oral anomalies (e.g., submucous cleft palate), hearing impairment, frank neurologic conditions associated with dyspraxia or dysarthria, and cognitive impairment. Co-occurrence with language disorders is quite common and the frequency of co-occurrence with voice disorders and with stuttering also appears to be elevated.
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