An articulation disorder occurs when a child produces a distorted sound, such as a lisp (i.e., incorrect tongue placement during /s, z/ sounds) or an /r/ sound with a “flat” or vowelized quality (“spiduh” for “spider”). It is worth noting that an “articulation disorder” has become a generalized label used to also describe patterns of errors in speech, for instance, “tat” for “cat” or “wion” for “lion,” which is a substitution rather than sound distortion. Many therapists will address substitution errors using a “sound-by-sound” approach if there are only a few errors. Nevertheless, it is important to understand that speech altogether is a learned movement pattern, just like walking, for example. A motor pathway of nerves in the brain is developed, established, and practiced, at a very early age.
The “give ‘em some time!” myth
Pediatricians and therapists often advise parents to “give it some time” before they seek out the help of a professional, leaving parents wondering why. Professionally, I am a supporter of the “wait and see” approach if the child demonstrates correct productions in some words, but not all, during their conversational speech. A child’s awareness of their speech increases as their gross and fine motor skills also develop and mature. As a result, common speech distortions may resolve with postural maturity, improved fine oral motor control, or exposure to same-aged peers which increases a child’s awareness. However, at the age of 4-years old, a child should be understood by familiar and unfamiliar listeners 90% of the time. Similarly, children who are typically developing demonstrate rapid growth of speech articulation skills in 6-month increments.
I advise parents to ask themselves the following:
- Has my child’s speech become easier to understand or made improvements at any time over a 6-month period?
- Can my child make the sound correctly at any time in spontaneous speech?
- Can my child make the sound correctly after I make the sound?
- Can acquaintances understand my child’s speech?
If any of the above answers are “no,” it may be time to consult with a speech-language pathologist regarding a full speech-language evaluation, especially if your child is approaching kindergarten. During the evaluation, the therapist will determine oral-structural abnormalities, evaluate for substitutions and omissions of sounds, and trial therapy techniques to determine the prognosis. The therapist may also hear the impact of reduced speech-articulation on language skills. In my experience, children typically respond well to treatment unless structural differences (e.g., tongue tie, high palate, cleft palate) exist that impact their ability to produce the sound physically. In that case, a referral to an orthodontist, otolaryngologist, craniofacial specialist, may be warranted.
So, what does articulation therapy look like? Speech therapy for an articulation disorder is focused on creating a new movement pathway in the brain, “weakening,” or just simply not using the distortion pathway. Therefore, intervention should be repetitive and intensive in nature once the correct sound placement is achieved.
The process of articulation therapy includes producing the sound at specific levels of speech:
- Establishing awareness of incorrect productions
- Story re-tell
- Conversational speech
Many parents ask how long it takes to re-mediate an articulation disorder. Progress depends on consistency regarding the child’s attendance, treatment frequency and productivity/number of repetitions during speech sessions and completion of home practice assignments on a daily basis. I often set a goal to help the child achieve the sound hundreds of times per session. Once a child has established a sound by itself consistently, the therapist will challenge the child to produce it in words, phrases, sentences, etc. Many children will use their sound perfectly while practicing their articulation cards but become completely unaware of errors made as they speak spontaneously. Awareness and self-monitoring spontaneous speech is the most challenging part of articulation therapy. I explain this to kiddos I see to remind them that un-doing the speech distortion takes time! We ultimately want the child to use the new motor pathway without the need to actively self-monitor. Therefore, treatment is most effective when the child makes hundreds of productions per session and engages in daily home practice as directed by the SLP.
This is what you can do to work on speech:
- Pick a daily routine to coincide with repetitive practice: before brushing teeth at night, during breakfast in the morning, on the way to school, etc.
- Require your child to use correct speech while talking in the car, during dinner time, or while speaking on the phone.
- Encourage your child to sing their favorite songs or nursery rhymes using their correct sound. For a challenge, make them start over if you catch an error!
- Play games like “Guess Who?,” “Connect Four,” or “Sorry” and use a target word or phrase with their sound in it each time they take a turn.
- Combine homework assignments and speech practice into one activity! Encourage your child to read the directions with correct speech, identify/practice vocabulary words that have the sound, or read stories aloud.
NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!