Help: People Can’t Understand My Kid! When to Seek Professional Help
As parents, we remember with fondness the cute ways our kids mispronounced words when they were little. One of my kids had trouble with her “th” sound until she was about five. We used to go on bike rides around our neighborhood, and she would point out all the “thistle” flowers along the way, happily shouting “fistle, fistle” on repeat. Her sister coined the phrase “messoghetti” for pasta with tomato sauce. These errors were outgrown, though their disappearance may have felt bittersweet to me.
But when are speech sound errors normal and when should you be concerned? The simple answer is, if something doesn’t feel right to you as a parent, ask your pediatrician or schedule an evaluation with a speech-language pathologist. It is important to remember that just like with other milestones–walking, potty training, etc.–children don’t all meet speech milestones at exactly the same time. However, there are some benchmarks that can help you separate typical speech development from speech delays or disorders.
Intelligibility
One important measure of speech sound development is overall intelligibility–how much of a child’s speech can be understood. Measures of intelligibility vary significantly based on factors like who is listening and what contextual information is available. Parents and familiar listeners can often understand 50% of speech by age 2, 75% by 3, and 100% (although some errors may be present) at age 4. Unfamiliar listeners, without the benefit of context, understand about 50% by age 4, 75% at 5, and 90% at age 7.
Pattern-Based Errors
As children learn to talk, they use rule-based sound substitutions, or phonological processes, to make speech easier. This is a typical process; however, when rule-based errors persist beyond the expected age of elimination, speech therapy can help. Here are some common error patterns and their likely age of elimination:
Developmental Phonological Processes
Final Consonant Deletion (No for Nose); eliminated by 3
Fronting (Tar for Car); eliminated by 4
Stopping (Doo for Zoo); eliminated by 3-5
Consonant Cluster Reduction (Top for Stop); eliminated by 4-5
Gliding (Weg for Leg, Wed for Red); eliminated by 6-7
For more information on phonological error patterns, click here.
Some error patterns are considered atypical and should indicate the need for an evaluation at any age:
Atypical Phonological Processes
Backing of Consonants (Kea for Tea, Gough for Dough)
Initial Consonant Deletion (At for Cat)
Glottal Replacement (Substitution of a throat constriction sound for typical consonants)
Stopping of Glides (Des for Yes, Ben for When)
Articulation Errors
A child with articulation-based errors has trouble producing a particular speech sound correctly. These errors are often limited to one or two sounds and are based on the movements of articulators (tongue, teeth, lips, jaw) as opposed to rule-based phonological errors. Sounds commonly in error include /s/ (75% acquire by age 5). The /s/ sound may be “fronted” and sound like a “th,” or it may be “lateralized” and sound slushy. A fronted /s/ may be normal until about the age of 5, but a lateral /s/ is atypical at any age and should prompt an evaluation. The /r/ (75% acquire by age 5.5) and /th/ (75% acquire by age 6) sounds are also common articulation errors. For more information about expected ages for consonant acquisition, click here.
Structure-Based Articulation Errors
Occasionally, structural anomalies may result in speech sound errors or distortions. Examples include cleft palate, size and position of the tongue in the oral cavity, craniofacial differences, or enlarged tonsils or adenoids. If your physician or speech therapist suspects a structural basis for a speech sound disorder, they may provide a referral to a medical specialist to address structural concerns in addition to speech therapy.
Motor Speech Disorders
Speech difficulties may result from muscle weakness or reduced coordination. These disorders often result from an injury, such as a traumatic brain injury or stroke, or certain medical conditions, such as cerebral palsy or muscular dystrophy. Occasionally motor speech disorders present without a known cause.
Childhood Apraxia of Speech results from difficulty planning and coordinating movements for speech. Children with this condition often exhibit low intelligibility, and signs include inconsistent errors on consonants and vowels in repeated productions of words or syllables, lengthened and disrupted coarticulatory transitions between sounds and syllables (may sound like sound prolongations or staccato speech), and inappropriate stress within words and phrases.
Developmental Dysarthria results from muscle weakness and may appear as difficulty moving articulators, slurred speech, quiet or loud speech, hoarseness or breathiness, nasal speech or “stuffy nose” speech, or unnatural rate.
Red Flag Signs
Some childhood speech sound errors will naturally disappear as speech sound skills mature, but there are signs that a speech sound assessment is needed. These include:
Extremely low intelligibility by the age of 3
Developmental phonological error patterns that persist beyond the age of expected elimination
Atypical phonological error patterns at any age
A lateralized (slushy) /s, z/ at any age
Consonant distortions that persist beyond the expected age of acquisition
Vowel errors persisting past the age of 3
Concerns for structural articulation or motor speech errors at any age
Would you like to schedule a speech evaluation? Visit our evaluation hub or call our office at 515-218-8445.
Sources:
American Speech-Language-Hearing Association. (n.d.) Consonant age of acquisition and Selected phonological processes (patterns).
Hustad, K. C., Mahr, T. J., Natzke, P., & Rathouz, P. J. (2021). Speech development between 30 and 119 months in typical children I: Intelligibility growth curves for single-word and multiword productions. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2021_JSLHR-21-00142
