Articulation Delays and Disorders
Articulation delays and disorders are one category of speech sound disorder. When a child has an articulation delay/disorder, they have difficulty positioning their articulators (tongue, lips, teeth, jaw) to make a specific sound or group of sounds. Types of articulation delays/disorders include:
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sibilant distortions (more commonly known as 'lisps')
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derhoticization (articulation difficulties with the 'r' sound)
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tongue protrusion (tongue protrudes between the teeth for sounds such as /t/ and /d/)
Assessment
During assessment, the SLP systematically samples and analyzes a child's speech to determine if their speech sound system is developing as expected. If there are sounds they haven't mastered yet, the SLP determines if the child's speech is:
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developmentally appropriate - their overall intelligibility and specific errors are as expected at their age,
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delayed - the rate of development is not as expected, but follows the typical pattern (e.g., their speech is like that of a younger child), or
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disordered - the child is exhibiting atypical errors which are not expected at any age.
Assessment will include:
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differential diagnosis - what type of speech sound delay/disorder does the child have (e.g., related to hearing impairment, articulation, phonological, motor speech)?
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identification of difficulties in other communication domains - does the child also have difficulties with language, voice, resonance, and/or fluency?
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stimulability testing - is the child responsive to cueing by the SLP?
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judgment of severity
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referral recommendations - does the child need to see another professional (e.g., audiologist) for further testing?
Treatment
When we help children with articulation delays and disorders learn to produce specific speech sounds, we teach them how to position and move their articulators (e.g., jaw, lips, tongue) and what the sound should sound like. We help them to identify when they are and are not producing the sound right so they can correct themselves. We also provide structured practice opportunities in which we systematically build their ability to produce the sound in increasingly difficult phonetic and linguistic contexts with decreasing levels of adult support. Over time, the child is able to spontaneously produce the sound automatically and effortless in everyday speech.
When a child has an articulation delay or disorder, the earlier treatment is started the better. This will prevent further practice of incorrect speech movements and minimize potential social impact (e.g., how to respond to teasing).
When considering whether or not to pursue treatment, a child's guardians should consider the following:
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Children do not 'grow out of' articulation delays/disorders - they will need treatment to acquire these skills.
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Although the child's speech errors may not have a functional or social impact on their lives now, it may in the future when they are older. To quote an adult client who had an untreated articulation disorder and was having difficulty being understood by clients on the telephone, "My parents thought it was 'cute' when I was a kid. Well, I'm no longer a kid and it's no longer cute."
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Avoid calling the child's errors 'cute' - depending on the child's age, they may be very aware that they don't speak like their peers do and may be being teased. Referring to it as 'cute' may unintentionally minimize what the child is feeling about their speech. There are other ways of talking with a child about their speech that are more effective at building their confidence.
Lisps
Lisps affect 'sibilant' sounds as in Sue, zoo, shoe, measure. They also affect other sounds as in choo and jump. Lisps result from incorrect tongue placement that distorts the sound.
The /s/ sound is produced by placing the tip of the tongue very close to the hard palate behind the upper front teeth. You can feel the location in your mouth - feel for the bumpy ridge of the hard palate behind your teeth. This is called the 'alveolar ridge'. At the same time, the sides of the tongue raise up and touch the hard palate and inner sides of the molars. This tongue position creates a narrow groove or channel along the middle of the tongue. Air then comes up from the lungs and passes through this narrow constriction. The air flow becomes turbulent, creating a 'hissing' quality.
Dentalized and Interdental Lisps
Sometimes a lisp is a normal part of speech development. Children may produce a dentalized or interdental lisp (aka frontal lisp) while learning to say 's', 'z', and 'sh'. When a child continues to produce these kinds of lisps after age 4 1/2, however, it may be considered a speech sound delay.
With a dentalized lisp, the tongue tip is too far forward. Instead of being close to the alveolar ridge, it rests behind the upper front teeth.
With an interdental lisp, the tongue tip is even farther forward. It rests between the front teeth. This type of lisp may sound similar to 'th'.
Hear and see a frontal lisp produced by an SLP here.
Lateral and Palatal Lisps
Other lisps are not part of normal speech development at any age. 'Lateral lisps' (bilateral and unilateral) and a 'palatal lisp' are considered speech sounds disorders and will not fade on their own.
With a lateral lisp, the tongue is incorrectly placed along it's middle and sides. There are different types of lateral lisps. With a unilateral lisp, the tongue moves away from the centre and off to one side of the mouth. Air escapes along the side of the tongue, creating a 'slushy' quality.
Hear and see a lateral lisp produced by an SLP here.
Hear a unilateral lisp produced by a 4-year old child here:
With a palatal lisp, the tongue is too far back in the mouth. The mid-section raises up and touches the back of the hard palate or even the front of the soft palate. Air escapes around the sides of the tongue. This is the least common type of lisp.
Hear and see a palatal lisp produced by an SLP here.
Treatment
All types of lisps are treatable by a speech-language pathologist. Treatment should be started as early as possible.
If your child is exhibiting a lisp and you would like to speak with one of our speech-language pathologists, contact us.
Typical Speech Sound Development
Click on the images below to view as a pdf.
Tongue Tie
Tongue tie ('ankloglossia') describes a condition present at birth in which the piece of tissue that runs from the floor of the mouth to the underside of the tongue ('lingual frenulum') is larger than usual. The lingual frenulum typically attaches to the underside of the tongue about halfway down its length. In the case of ankloglossia, this excess tissue means that the attachment extends too far forward, closer to the tongue tip. This can restrict the movement of the tongue (e.g., forward protrusion, elevation to the hard palate). Although there can be difficulties with breastfeeding and clearing food from the mouth, it typically does not affect speech except for in severe cases. Parents should speak with their doctor if they have questions about ankloglossia. A speech-language pathologist can evaluate implications for speech production.
Ankloglossia. Image from "Netter's Head and Neck Anatomy for Dentistry" p. 420.