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Home / Blog

Speech Impediment Guide: Definition, Causes, and Resources

December 8, 2020 

Tables of Contents

What Is a Speech Impediment?

Types of speech disorders, speech impediment causes, how to fix a speech impediment, making a difference in speech disorders.

Communication is a cornerstone of human relationships. When an individual struggles to verbalize information, thoughts, and feelings, it can cause major barriers in personal, learning, and business interactions.

Speech impediments, or speech disorders, can lead to feelings of insecurity and frustration. They can also cause worry for family members and friends who don’t know how to help their loved ones express themselves.

Fortunately, there are a number of ways that speech disorders can be treated, and in many cases, cured. Health professionals in fields including speech-language pathology and audiology can work with patients to overcome communication disorders, and individuals and families can learn techniques to help.

Commonly referred to as a speech disorder, a speech impediment is a condition that impacts an individual’s ability to speak fluently, correctly, or with clear resonance or tone. Individuals with speech disorders have problems creating understandable sounds or forming words, leading to communication difficulties.

Some 7.7% of U.S. children — or 1 in 12 youths between the ages of 3 and 17 — have speech, voice, language, or swallowing disorders, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). About 70 million people worldwide, including some 3 million Americans, experience stuttering difficulties, according to the Stuttering Foundation.

Common signs of a speech disorder

There are several symptoms and indicators that can point to a speech disorder.

• Unintelligible speech — A speech disorder may be present when others have difficulty understanding a person’s verbalizations.
• Omitted sounds — This symptom can include the omission of part of a word, such as saying “bo” instead of “boat,” and may include omission of consonants or syllables.
• Added sounds — This can involve adding extra sounds in a word, such as “buhlack” instead of “black,” or repeating sounds like “b-b-b-ball.”
• Substituted sounds — When sounds are substituted or distorted, such as saying “wabbit” instead of “rabbit,” it may indicate a speech disorder.
• Use of gestures — When individuals use gestures to communicate instead of words, a speech impediment may be the cause.
• Inappropriate pitch — This symptom is characterized by speaking with a strange pitch or volume.

In children, signs might also include a lack of babbling or making limited sounds. Symptoms may also include the incorrect use of specific sounds in words, according to the American Speech-Language-Hearing Association (ASHA). This may include the sounds p, m, b, w, and h among children aged 1-2, and k, f, g, d, n, and t for children aged 2-3.

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Categories of Speech Impediments

Speech impediments can range from speech sound disorders (articulation and phonological disorders) to voice disorders. Speech sound disorders may be organic — resulting from a motor or sensory cause — or may be functional with no known cause. Voice disorders deal with physical problems that limit speech. The main categories of speech impediments include the following:

Fluency disorders occur when a patient has trouble with speech timing or rhythms. This can lead to hesitations, repetitions, or prolonged sounds. Fluency disorders include stuttering (repetition of sounds) or   (rapid or irregular rate of speech).

Resonance disorders are related to voice quality that is impacted by the shape of the nose, throat, and/or mouth. Examples of resonance disorders include hyponasality and cul-de-sac resonance.

Articulation disorders occur when a patient has difficulty producing speech sounds. These disorders may stem from physical or anatomical limitations such as muscular, neuromuscular, or skeletal support. Examples of articulation speech impairments include sound omissions, substitutions, and distortions.

Phonological disorders result in the misuse of certain speech sounds to form words. Conditions include fronting, stopping, and the omission of final consonants.

Voice disorders are the result of problems in the larynx that harm the quality or use of an individual’s voice. This can impact pitch, resonance, and loudness.

Impact of Speech Disorders

Some speech disorders have little impact on socialization and daily activities, but other conditions can make some tasks difficult for individuals. Following are a few of the impacts of speech impediments.

• Poor communication — Children may be unable to participate in certain learning activities, such as answering questions or reading out loud, due to communication difficulties. Adults may avoid work or social activities such as giving speeches or attending parties.
• Mental health and confidence — Speech disorders may cause children or adults to feel different from peers, leading to a lack of self-confidence and, potentially, self-isolation.

Resources on Speech Disorders

The following resources may help those who are seeking more information about speech impediments.

Health Information : Information and statistics on common voice and speech disorders from the NIDCD

Speech Disorders : Information on childhood speech disorders from Cincinnati Children’s Hospital Medical Center

Speech, Language, and Swallowing : Resources about speech and language development from the ASHA

Children and adults can suffer from a variety of speech impairments that may have mild to severe impacts on their ability to communicate. The following 10 conditions are examples of specific types of speech disorders and voice disorders.

1. Stuttering

This condition is one of the most common speech disorders. Stuttering is the repetition of syllables or words, interruptions in speech, or prolonged use of a sound.

This organic speech disorder is a result of damage to the neural pathways that connect the brain to speech-producing muscles. This results in a person knowing what they want to say, but being unable to speak the words.

This consists of the lost ability to speak, understand, or write languages. It is common in stroke, brain tumor, or traumatic brain injury patients.

4. Dysarthria

This condition is an organic speech sound disorder that involves difficulty expressing certain noises. This may involve slurring, or poor pronunciation, and rhythm differences related to nerve or brain disorders.

The condition of lisping is the replacing of sounds in words, including “th” for “s.” Lisping is a functional speech impediment.

6. Hyponasality

This condition is a resonance disorder related to limited sound coming through the nose, causing a “stopped up” quality to speech.

7. Cul-de-sac resonance

This speech disorder is the result of blockage in the mouth, throat, or nose that results in quiet or muffled speech.

8. Orofacial myofunctional disorders

These conditions involve abnormal patterns of mouth and face movement. Conditions include tongue thrusting (fronting), where individuals push out their tongue while eating or talking.

9. Spasmodic Dysphonia

This condition is a voice disorder in which spasms in the vocal cords produce speech that is hoarse, strained, or jittery.

10. Other voice disorders

These conditions can include having a voice that sounds breathy, hoarse, or scratchy. Some disorders deal with vocal folds closing when they should open (paradoxical vocal fold movement) or the presence of polyps or nodules in the vocal folds.

Speech Disorders vs. Language Disorders

Speech disorders deal with difficulty in creating sounds due to articulation, fluency, phonology, and voice problems. These problems are typically related to physical, motor, sensory, neurological, or mental health issues.

Language disorders, on the other hand, occur when individuals have difficulty communicating the meaning of what they want to express. Common in children, these disorders may result in low vocabulary and difficulty saying complex sentences. Such a disorder may reflect difficulty in comprehending school lessons or adopting new words, or it may be related to a learning disability such as dyslexia. Language disorders can also involve receptive language difficulties, where individuals have trouble understanding the messages that others are trying to convey.  

Resources on Types of Speech Disorders

The following resources may provide additional information on the types of speech impediments.

Common Speech Disorders: A guide to the most common speech impediments from GreatSpeech

Speech impairment in adults: Descriptions of common adult speech issues from MedlinePlus

Stuttering Facts: Information on stuttering indications and causes from the Stuttering Foundation

Speech disorders may be caused by a variety of factors related to physical features, neurological ailments, or mental health conditions. In children, they may be related to developmental issues or unknown causes and may go away naturally over time.

Physical and neurological issues. Speech impediment causes related to physical characteristics may include:

• Brain damage
• Nervous system damage
• Respiratory system damage
• Hearing difficulties
• Cancerous or noncancerous growths
• Muscle and bone problems such as dental issues or cleft palate

Mental health issues. Some speech disorders are related to clinical conditions such as:

• Autism spectrum disorder
• Down syndrome or other genetic syndromes
• Cerebral palsy or other neurological disorders
• Multiple sclerosis

Some speech impairments may also have to do with family history, such as when parents or siblings have experienced language or speech difficulties. Other causes may include premature birth, pregnancy complications, or delivery difficulties. Voice overuse and chronic coughs can also cause speech issues.

The most common way that speech disorders are treated involves seeking professional help. If patients and families feel that symptoms warrant therapy, health professionals can help determine how to fix a speech impediment. Early treatment is best to curb speech disorders, but impairments can also be treated later in life.

Professionals in the speech therapy field include speech-language pathologists (SLPs) . These practitioners assess, diagnose, and treat communication disorders including speech, language, social, cognitive, and swallowing disorders in both adults and children. They may have an SLP assistant to help with diagnostic and therapy activities.

Speech-language pathologists may also share a practice with audiologists and audiology assistants. Audiologists help identify and treat hearing, balance, and other auditory disorders.

How Are Speech Disorders Diagnosed?

Typically, a pediatrician, social worker, teacher, or other concerned party will recognize the symptoms of a speech disorder in children. These individuals, who frequently deal with speech and language conditions and are more familiar with symptoms, will recommend that parents have their child evaluated. Adults who struggle with speech problems may seek direct guidance from a physician or speech evaluation specialist.

When evaluating a patient for a potential speech impediment, a physician will:

• Conduct hearing and vision tests
• Evaluate patient records
• Observe patient symptoms

A speech-language pathologist will conduct an initial screening that might include:

• An evaluation of speech sounds in words and sentences
• An evaluation of oral motor function
• An orofacial examination
• An assessment of language comprehension

The initial screening might result in no action if speech symptoms are determined to be developmentally appropriate. If a disorder is suspected, the initial screening might result in a referral for a comprehensive speech sound assessment, comprehensive language assessment, audiology evaluation, or other medical services.

Initial assessments and more in-depth screenings might occur in a private speech therapy practice, rehabilitation center, school, childcare program, or early intervention center. For older adults, skilled nursing centers and nursing homes may assess patients for speech, hearing, and language disorders.

How Are Speech Impediments Treated?

Once an evaluation determines precisely what type of speech sound disorder is present, patients can begin treatment. Speech-language pathologists use a combination of therapy, exercise, and assistive devices to treat speech disorders.

Speech therapy might focus on motor production (articulation) or linguistic (phonological or language-based) elements of speech, according to ASHA. There are various types of speech therapy available to patients.

Contextual Utilization  — This therapeutic approach teaches methods for producing sounds consistently in different syllable-based contexts, such as phonemic or phonetic contexts. These methods are helpful for patients who produce sounds inconsistently.

Phonological Contrast — This approach focuses on improving speech through emphasis of phonemic contrasts that serve to differentiate words. Examples might include minimal opposition words (pot vs. spot) or maximal oppositions (mall vs. call). These therapy methods can help patients who use phonological error patterns.

Distinctive Feature — In this category of therapy, SLPs focus on elements that are missing in speech, such as articulation or nasality. This helps patients who substitute sounds by teaching them to distinguish target sounds from substituted sounds.

Core Vocabulary — This therapeutic approach involves practicing whole words that are commonly used in a specific patient’s communications. It is effective for patients with inconsistent sound production.

Metaphon — In this type of therapy, patients are taught to identify phonological language structures. The technique focuses on contrasting sound elements, such as loud vs. quiet, and helps patients with unintelligible speech issues.

Oral-Motor — This approach uses non-speech exercises to supplement sound therapies. This helps patients gain oral-motor strength and control to improve articulation.

Other methods professionals may use to help fix speech impediments include relaxation, breathing, muscle strengthening, and voice exercises. They may also recommend assistive devices, which may include:

• Radio transmission systems
• Personal amplifiers
• Picture boards
• Touch screens
• Text displays
• Speech-generating devices
• Hearing aids
• Cochlear implants

Resources for Professionals on How to Fix a Speech Impediment

The following resources provide information for speech therapists and other health professionals.

Assistive Devices: Information on hearing and speech aids from the NIDCD

Information for Audiologists: Publications, news, and practice aids for audiologists from ASHA

Information for Speech-Language Pathologists: Publications, news, and practice aids for SLPs from ASHA

Speech Disorder Tips for Families

For parents who are concerned that their child might have a speech disorder — or who want to prevent the development of a disorder — there are a number of activities that can help. The following are tasks that parents can engage in on a regular basis to develop literacy and speech skills.

• Introducing new vocabulary words
• Reading picture and story books with various sounds and patterns
• Talking to children about objects and events
• Answering children’s questions during routine activities
• Encouraging drawing and scribbling
• Pointing to words while reading books
• Pointing out words and sentences in objects and signs

Parents can take the following steps to make sure that potential speech impediments are identified early on.

• Discussing concerns with physicians
• Asking for hearing, vision, and speech screenings from doctors
• Requesting special education assessments from school officials
• Requesting a referral to a speech-language pathologist, audiologist, or other specialist

When a child is engaged in speech therapy, speech-language pathologists will typically establish collaborative relationships with families, sharing information and encouraging parents to participate in therapy decisions and practices.

SLPs will work with patients and their families to set goals for therapy outcomes. In addition to therapy sessions, they may develop activities and exercises for families to work on at home. It is important that caregivers are encouraging and patient with children during therapy.  

Resources for Parents on How to Fix a Speech Impediment

The following resources provide additional information on treatment options for speech disorders.

Speech, Language, and Swallowing Disorders Groups: Listing of self-help groups from ASHA

ProFind: Search tool for finding certified SLPs and audiologists from ASHA

Baby’s Hearing and Communication Development Checklist: Listing of milestones that children should meet by certain ages from the NIDCD

If identified during childhood, speech disorders can be corrected efficiently, giving children greater communication opportunities. If left untreated, speech impediments can cause a variety of problems in adulthood, and may be more difficult to diagnose and treat.

Parents, teachers, doctors, speech and language professionals, and other concerned parties all have unique responsibilities in recognizing and treating speech disorders. Through professional therapy, family engagement, positive encouragement and a strong support network, individuals with speech impediments can overcome their challenges and develop essential communication skills.

Additional Sources

American Speech-Language-Hearing Association, Speech Sound Disorders

Identify the Signs, Signs of Speech and Language Disorders

Intermountain Healthcare, Phonological Disorders

MedlinePlus, Speech disorders – children

National Institutes of Health, National Institutes on Deafness and Other Communication Disorders, “Quick Statistics About Voice, Speech, Language”

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speech impediment

Definition of speech impediment

Examples of speech impediment in a sentence.

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'speech impediment.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

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“Speech impediment.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/speech%20impediment. Accessed 12 Sep. 2024.

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

What is a speech impairment?

A speech impairment refers to an impaired ability to produce speech sounds and may range from mild to severe. It may include an articulation disorder, characterized by omissions or distortions of speech sounds; a fluency disorder, characterized by atypical flow, rhythm, and/or repetitions of sounds; or a voice disorder, characterized by abnormal pitch, volume, resonance, vocal quality, or duration.

The American Speech-Language Hearing Association (ASHA) has published its official definitions in Definitions of Communication Disorders and Variations .

Additional information is available from Speech and Language Impairments  hosted by the Center for Parent Information and Resources.

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Dysarthria happens when the muscles used for speech are weak or are hard to control. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include conditions that affect the nervous system or that cause facial paralysis. These conditions may cause tongue or throat muscle weakness. Certain medicines also can cause dysarthria.

Treating the underlying cause of dysarthria may improve your speech. You also may need speech therapy. For dysarthria caused by prescription medicines, changing or stopping the medicines may help.

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Symptoms of dysarthria depend on the underlying cause and the type of dysarthria.

Symptoms may include:

• Slurred speech.
• Slow speech.
• Not being able to speak louder than a whisper or speaking too loudly.
• Rapid speech that is difficult to understand.
• Nasal, raspy or strained voice.
• Uneven speech rhythm.
• Uneven speech volume.
• Monotone speech.
• Trouble moving your tongue or facial muscles.

When to see a doctor

Dysarthria can be a sign of a serious condition. See a healthcare professional right away if you have sudden or unexplained changes in your ability to speak.

Dysarthria can be caused by conditions that make it hard to move the muscles in the mouth, face or upper respiratory system. These muscles control speech.

Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease.
• Brain injury.
• Brain tumor.
• Cerebral palsy.
• Guillain-Barre syndrome.
• Head injury.
• Huntington's disease.
• Lyme disease.
• Multiple sclerosis.
• Muscular dystrophy.
• Myasthenia gravis.
• Parkinson's disease.
• Wilson's disease.

Some medicines also can cause dysarthria. These may include certain sedatives and seizure medicines.

Risk factors

Dysarthria risk factors include having a neurological condition that affects the muscles that control speech.

Complications

Complications of dysarthria may come from having trouble with communication. Complications may include:

• Trouble socializing. Communication problems may affect your relationships with family and friends. These problems also may make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Jankovic J, et al., eds. Dysarthria and apraxia of speech. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 27, 2024.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/dysarthria-in-adults/. Accessed March 27, 2024.
• Drugs possibly associated with dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 4, 2024.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed March 27, 2024.
• Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. https://catalog.ninds.nih.gov/publications/neurological-diagnostic-tests-and-procedures. Accessed March 27, 2024.

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What Is a Speech Sound Disorder?

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Speech sound disorders are a blanket description for a child’s difficulty in learning, articulating, or using the sounds/sound patterns of their language. These difficulties are usually clear when compared to the communication abilities of children within the same age group.

Speech developmental disorders may indicate challenges with motor speech. Here, a child experiences difficulty moving the muscles necessary for speech production. This child may also face reduced coordination when attempting to speak.

Speech sound disorders are recognized where speech patterns do not correspond with the movements/gestures made when speaking.  

Speech impairments are a common early childhood occurrence—an estimated 2% to 13% of children live with these difficulties. Children with these disorders may struggle with reading and writing. This can interfere with their expected academic performance. Speech sound disorders are often confused with language conditions such as specific language impairment (SLI).

This article will examine the distinguishing features of this disorder. It will also review factors responsible for speech challenges, and the different ways they can manifest. Lastly, we’ll cover different treatment methods that make managing this disorder possible.

Symptoms of Speech Sound Disorder

A speech sound disorder may manifest in different ways. This usually depends on the factors responsible for the challenge, or how extreme it is.

There are different patterns of error that may signal a speech sound disorder. These include:

• Removing a sound from a word
• Including a sound in a word
• Replacing hard to pronounce sounds with an unsuitable alternative
• Difficulty pronouncing the same sound in different words (e.g., "pig" and "kit")
• Repeating sounds or words
• Lengthening words
• Pauses while speaking
• Tension when producing sounds
• Head jerks during speech
• Blinking while speaking
• Shame while speaking
• Changes in voice pitch
• Running out of breath while speaking

It’s important to note that children develop at different rates. This can reflect in the ease and ability to produce sounds. But where children repeatedly make sounds or statements that are difficult to understand, this could indicate a speech disorder.

Diagnosis of Speech Sound Disorders

For a correct diagnosis, a speech-language pathologist can determine whether or not a child has a speech-sound disorder.

This determination may be made in line with the requirements of the DSM-5 diagnostic criteria . These guidelines require that:

• The child experience persistent difficulty with sound production (this affects communication and speech comprehension)
• Symptoms of the disorder appear early during the child’s development stages
• This disorder limits communication. It affects social interactions, academic achievements, and job performance.
• The disorder is not caused by other conditions like a congenital disorder or an acquired condition like hearing loss . Hereditary disorders are, however, exempted. 

Causes of Speech Sound Disorders

There is no known cause of speech sound disorders. However, several risk factors may increase the odds of developing a speech challenge. These include:

• Gender : Male children are more likely to develop a speech sound disorder
• Family history : Children with family members living with speech disorders may acquire a similar challenge.
• Socioeconomics : Being raised in a low socioeconomic environment may contribute to the development of speech and literacy challenges.
• Pre- and post-natal challenges : Difficulties faced during pregnancy such as maternal infections and stressors may worsen the chances of speech disorders in a child. Likewise, delivery complications, premature birth, and low-birth-weight could lead to speech disorders.
• Disabilities : Down syndrome, autism , and other disabilities may be linked to speech-sound disorders.
• Physical challenges : Children with a cleft lip may experience speech sound difficulties.
• Brain damage : These disorders may also be caused by an infection or trauma to a child’s brain . This is seen in conditions like cerebral palsy where the muscles affecting speech are injured.

Types of Speech Sound Disorders

By the time a child turns three, at least half of what they say should be properly understood. By ages four and five, most sounds should be pronounced correctly—although, exceptions may arise when pronouncing “l”, “s”,”r”,”v”, and other similar sounds. By seven or eight, harder sounds should be properly pronounced. 

A child with a speech sound disorder will continue to struggle to pronounce words, even past the expected age. Difficulty with speech patterns may signal one of the following speech sound disorders:

This refers to interruptions while speaking. Stuttering is the most common form of disfluency. It is recognized for recurring breaks in the free flow of speech. After the age of four, a child with disfluency will still repeat words or phrases while speaking. This child may include extra words or sounds when communicating—they may also make words longer by stressing syllables.

This disorder may cause tension while speaking. Other times, head jerking or blinking may be observed with disfluency. 

Children with this disorder often feel frustrated when speaking, it may also cause embarrassment during interactions. 

Articulation Disorder

When a child is unable to properly produce sounds, this may be caused by inexact placement, speed, pressure, or movement from the lips, tongue, or throat.  

This usually signals an articulation disorder, where sounds like “r”, “l”, or “s” may be changed. In these cases, a child’s communication may be understood by only close family members.

Phonological Disorder

A phonological disorder is present where a child is unable to make the speech sounds expected of their age. Here, mistakes may be made when producing sounds. Other times, sounds like consonants may be omitted when speaking.  

Voice Disorder

Where a child is observed to have a raspy voice, this may be an early sign of a voice disorder. Other indicators include voice breaks, a change in pitch, or an excessively loud or soft voice.  

Children that run out of breath while speaking may also live with this disorder. Likewise, children may sound very nasally, or can appear to have inadequate air coming out of their nose if they have a voice disorder.

Childhood apraxia of speech occurs when a child lacks the proper motor skills for sound production. Children with this condition will find it difficult to plan and produce movements in the tongue, lips, jaw, and palate required for speech.  

Treatment of Speech Sound Disorder

Parents of children with speech sound disorders may feel at a loss for the next steps to take. To avoid further strain to the child, it’s important to avoid showing excessive concern.

Instead, listening patiently to their needs, letting them speak without completing their sentences, and showing usual love and care can go a long way.

For professional assistance, a speech-language pathologist can assist with improving a child’s communication. These pathologists will typically use oral motor exercises to enhance speech.

These oral exercises may also include nonspeech oral exercises such as blowing, oral massages and brushing, cheek puffing, whistleblowing, etc.

Nonspeech oral exercises help to strengthen weak mouth muscles, and can help with learning the common ways of communicating.

Parents and children with speech sound disorders may also join support groups for information and assistance with the condition.

A Word From Verywell

It can be frustrating to witness the challenges in communication. But while it's understandable to long for typical communication from a child—the differences caused by speech disorders can be managed with the right care and supervision. Speaking to a speech therapist, and showing love o children with speech disorders can be important first steps in overcoming these conditions.

Eadie P, Morgan A, Ukoumunne OC, Ttofari Eecen K, Wake M, Reilly S. Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children . Dev Med Child Neurol . 2015;57(6):578-584. doi:10.1111/dmcn.12635

McLeod S, Harrison LJ, McAllister L, McCormack J. Speech sound disorders in a community study of preschool children . Am J Speech Lang Pathol . 2013;22(3):503-522. doi:10.1044/1058-0360(2012/11-0123)

Murphy CF, Pagan-Neves LO, Wertzner HF, Schochat E. Children with speech sound disorder: comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills . Front Psychol . 2015;6:64. Published 2015 Feb 4. doi:10.3389/fpsyg.2015.00064

Penn Medicine. Speech and Language Disorders-Symptoms and Causes .

PsychDB. Speech Sound Disorder (Phonological Disorder) .

Sices L, Taylor HG, Freebairn L, Hansen A, Lewis B. Relationship between speech-sound disorders and early literacy skills in preschool-age children: impact of comorbid language impairment . J Dev Behav Pediatr . 2007;28(6):438-447. doi:10.1097/DBP.0b013e31811ff8ca

American Speech-Language-Hearing Association. Speech Sound Disorders: Articulation and Phonology .

American Speech-Language-Hearing Association. Speech Sound Disorders .

MedlinePlus. Phonological Disorder .

National Institute on Deafness and Other Communication Disorders. Articulation Disorder .

National Institute of Health. Phonological Disorder.

Lee AS, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders . Cochrane Database Syst Rev . 2015;2015(3):CD009383. Published 2015 Mar 25. doi:10.1002/14651858.CD009383.pub2

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

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Meaning of speech impediment in English

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• speech and language therapist
• speech and language therapy
• stammeringly
• stutteringly

Examples of speech impediment

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10 Most Common Speech-Language Disorders & Impediments

As you get to know more about the field of speech-language pathology you’ll increasingly realize why SLPs are required to earn at least a master’s degree . This stuff is serious – and there’s nothing easy about it.

In 2016 the National Institute on Deafness and Other Communication Disorders reported that 7.7% of American children have been diagnosed with a speech or swallowing disorder. That comes out to nearly one in 12 children, and gets even bigger if you factor in adults.

Whether rooted in psycho-speech behavioral issues, muscular disorders, or brain damage, nearly all the diagnoses SLPs make fall within just 10 common categories…

Types of Speech Disorders & Impediments

Apraxia of speech (aos).

Apraxia of Speech (AOS) happens when the neural pathway between the brain and a person’s speech function (speech muscles) is lost or obscured. The person knows what they want to say – they can even write what they want to say on paper – however the brain is unable to send the correct messages so that speech muscles can articulate what they want to say, even though the speech muscles themselves work just fine. Many SLPs specialize in the treatment of Apraxia .

There are different levels of severity of AOS, ranging from mostly functional, to speech that is incoherent. And right now we know for certain it can be caused by brain damage, such as in an adult who has a stroke. This is called Acquired AOS.

However the scientific and medical community has been unable to detect brain damage – or even differences – in children who are born with this disorder, making the causes of Childhood AOS somewhat of a mystery. There is often a correlation present, with close family members suffering from learning or communication disorders, suggesting there may be a genetic link.

Mild cases might be harder to diagnose, especially in children where multiple unknown speech disorders may be present. Symptoms of mild forms of AOS are shared by a range of different speech disorders, and include mispronunciation of words and irregularities in tone, rhythm, or emphasis (prosody).

Stuttering – Stammering

Stuttering, also referred to as stammering, is so common that everyone knows what it sounds like and can easily recognize it. Everyone has probably had moments of stuttering at least once in their life. The National Institute on Deafness and Other Communication Disorders estimates that three million Americans stutter, and reports that of the up-to-10-percent of children who do stutter, three-quarters of them will outgrow it. It should not be confused with cluttering.

Most people don’t know that stuttering can also include non-verbal involuntary or semi-voluntary actions like blinking or abdominal tensing (tics). Speech language pathologists are trained to look for all the symptoms of stuttering , especially the non-verbal ones, and that is why an SLP is qualified to make a stuttering diagnosis.

The earliest this fluency disorder can become apparent is when a child is learning to talk. It may also surface later during childhood. Rarely if ever has it developed in adults, although many adults have kept a stutter from childhood.

Stuttering only becomes a problem when it has an impact on daily activities, or when it causes concern to parents or the child suffering from it. In some people, a stutter is triggered by certain events like talking on the phone. When people start to avoid specific activities so as not to trigger their stutter, this is a sure sign that the stutter has reached the level of a speech disorder.

The causes of stuttering are mostly a mystery. There is a correlation with family history indicating a genetic link. Another theory is that a stutter is a form of involuntary or semi-voluntary tic. Most studies of stuttering agree there are many factors involved.

Dysarthria is a symptom of nerve or muscle damage. It manifests itself as slurred speech, slowed speech, limited tongue, jaw, or lip movement, abnormal rhythm and pitch when speaking, changes in voice quality, difficulty articulating, labored speech, and other related symptoms.

It is caused by muscle damage, or nerve damage to the muscles involved in the process of speaking such as the diaphragm, lips, tongue, and vocal chords.

Because it is a symptom of nerve and/or muscle damage it can be caused by a wide range of phenomena that affect people of all ages. This can start during development in the womb or shortly after birth as a result of conditions like muscular dystrophy and cerebral palsy. In adults some of the most common causes of dysarthria are stroke, tumors, and MS.

A lay term, lisping can be recognized by anyone and is very common.

Speech language pathologists provide an extra level of expertise when treating patients with lisping disorders . They can make sure that a lisp is not being confused with another type of disorder such as apraxia, aphasia, impaired development of expressive language, or a speech impediment caused by hearing loss.

SLPs are also important in distinguishing between the five different types of lisps. Most laypersons can usually pick out the most common type, the interdental/dentalised lisp. This is when a speaker makes a “th” sound when trying to make the “s” sound. It is caused by the tongue reaching past or touching the front teeth.

Because lisps are functional speech disorders, SLPs can play a huge role in correcting these with results often being a complete elimination of the lisp. Treatment is particularly effective when implemented early, although adults can also benefit.

Experts recommend professional SLP intervention if a child has reached the age of four and still has an interdental/dentalised lisp. SLP intervention is recommended as soon as possible for all other types of lisps. Treatment includes pronunciation and annunciation coaching, re-teaching how a sound or word is supposed to be pronounced, practice in front of a mirror, and speech-muscle strengthening that can be as simple as drinking out of a straw.

Spasmodic Dysphonia

Spasmodic Dysphonia (SD) is a chronic long-term disorder that affects the voice. It is characterized by a spasming of the vocal chords when a person attempts to speak and results in a voice that can be described as shaky, hoarse, groaning, tight, or jittery. It can cause the emphasis of speech to vary considerably. Many SLPs specialize in the treatment of Spasmodic Dysphonia .

SLPs will most often encounter this disorder in adults, with the first symptoms usually occurring between the ages of 30 and 50. It can be caused by a range of things mostly related to aging, such as nervous system changes and muscle tone disorders.

It’s difficult to isolate vocal chord spasms as being responsible for a shaky or trembly voice, so diagnosing SD is a team effort for SLPs that also involves an ear, nose, and throat doctor (otolaryngologist) and a neurologist.

Have you ever heard people talking about how they are smart but also nervous in large groups of people, and then self-diagnose themselves as having Asperger’s? You might have heard a similar lay diagnosis for cluttering. This is an indication of how common this disorder is as well as how crucial SLPs are in making a proper cluttering diagnosis .

A fluency disorder, cluttering is characterized by a person’s speech being too rapid, too jerky, or both. To qualify as cluttering, the person’s speech must also have excessive amounts of “well,” “um,” “like,” “hmm,” or “so,” (speech disfluencies), an excessive exclusion or collapsing of syllables, or abnormal syllable stresses or rhythms.

The first symptoms of this disorder appear in childhood. Like other fluency disorders, SLPs can have a huge impact on improving or eliminating cluttering. Intervention is most effective early on in life, however adults can also benefit from working with an SLP.

Muteness – Selective Mutism

There are different kinds of mutism, and here we are talking about selective mutism. This used to be called elective mutism to emphasize its difference from disorders that caused mutism through damage to, or irregularities in, the speech process.

Selective mutism is when a person does not speak in some or most situations, however that person is physically capable of speaking. It most often occurs in children, and is commonly exemplified by a child speaking at home but not at school.

Selective mutism is related to psychology. It appears in children who are very shy, who have an anxiety disorder, or who are going through a period of social withdrawal or isolation. These psychological factors have their own origins and should be dealt with through counseling or another type of psychological intervention.

Diagnosing selective mutism involves a team of professionals including SLPs, pediatricians, psychologists, and psychiatrists. SLPs play an important role in this process because there are speech language disorders that can have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria – and it’s important to eliminate these as possibilities.

And just because selective mutism is primarily a psychological phenomenon, that doesn’t mean SLPs can’t do anything. Quite the contrary.

The National Institute on Neurological Disorders and Stroke estimates that one million Americans have some form of aphasia.

Aphasia is a communication disorder caused by damage to the brain’s language capabilities. Aphasia differs from apraxia of speech and dysarthria in that it solely pertains to the brain’s speech and language center.

As such anyone can suffer from aphasia because brain damage can be caused by a number of factors. However SLPs are most likely to encounter aphasia in adults, especially those who have had a stroke. Other common causes of aphasia are brain tumors, traumatic brain injuries, and degenerative brain diseases.

In addition to neurologists, speech language pathologists have an important role in diagnosing aphasia. As an SLP you’ll assess factors such as a person’s reading and writing, functional communication, auditory comprehension, and verbal expression.

Speech Delay – Alalia

A speech delay, known to professionals as alalia, refers to the phenomenon when a child is not making normal attempts to verbally communicate. There can be a number of factors causing this to happen, and that’s why it’s critical for a speech language pathologist to be involved.

The are many potential reasons why a child would not be using age-appropriate communication. These can range anywhere from the child being a “late bloomer” – the child just takes a bit longer than average to speak – to the child having brain damage. It is the role of an SLP to go through a process of elimination, evaluating each possibility that could cause a speech delay, until an explanation is found.

Approaching a child with a speech delay starts by distinguishing among the two main categories an SLP will evaluate: speech and language.

Speech has a lot to do with the organs of speech – the tongue, mouth, and vocal chords – as well as the muscles and nerves that connect them with the brain. Disorders like apraxia of speech and dysarthria are two examples that affect the nerve connections and organs of speech. Other examples in this category could include a cleft palette or even hearing loss.

The other major category SLPs will evaluate is language. This relates more to the brain and can be affected by brain damage or developmental disorders like autism. There are many different types of brain damage that each manifest themselves differently, as well as developmental disorders, and the SLP will make evaluations for everything.

Issues Related to Autism

While the autism spectrum itself isn’t a speech disorder, it makes this list because the two go hand-in-hand more often than not.

The Centers for Disease Control and Prevention (CDC) reports that one out of every 68 children in our country have an autism spectrum disorder. And by definition, all children who have autism also have social communication problems.

Speech-language pathologists are often a critical voice on a team of professionals – also including pediatricians, occupational therapists, neurologists, developmental specialists, and physical therapists – who make an autism spectrum diagnosis .

In fact, the American Speech-Language Hearing Association reports that problems with communication are the first detectable signs of autism. That is why language disorders – specifically disordered verbal and nonverbal communication – are one of the primary diagnostic criteria for autism.

So what kinds of SLP disorders are you likely to encounter with someone on the autism spectrum?

A big one is apraxia of speech. A study that came out of Penn State in 2015 found that 64 percent of children who were diagnosed with autism also had childhood apraxia of speech.

This basic primer on the most common speech disorders offers little more than an interesting glimpse into the kind of issues that SLPs work with patients to resolve. But even knowing everything there is to know about communication science and speech disorders doesn’t tell the whole story of what this profession is all about. With every client in every therapy session, the goal is always to have the folks that come to you for help leave with a little more confidence than when they walked in the door that day. As a trusted SLP, you will build on those gains with every session, helping clients experience the joy and freedom that comes with the ability to express themselves freely. At the end of the day, this is what being an SLP is all about.

Ready to make a difference in speech pathology? Learn how to become a Speech-Language Pathologist today

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Calvin University - Calvin University's Online Speech and Hearing Foundations Certificate - Helps You Gain a Strong Foundation for Your Speech-Language Pathology Career.

Common Speech Impediments: Causes, Symptoms, Treatment, And Support

Speech impediments include a variety of both language and speech disorders, some of which can be addressed through  online speech therapy  with speech-language pathologists. They can arise because of heredity and genetics, developmental delays, or even damage to Broca’s area—the part of the brain that’s involved in language skills and speech skills. They may also be linked to other conditions like autism spectrum disorder, cerebral palsy, dyslexia, or even hearing loss. It depends on the type and the cause, but most speech impediments and speech impairments can be treated through speech therapy.

That said, recognizing when a speech impediment may be present can help you get yourself or your child the treatment and support they may need for improved academic and/or social functioning and self-confidence.

Common symptoms of a speech impediment

There are many different types of speech impediments a person can have, so the symptoms can vary. However, it’s important to understand what symptoms may indicate a speech disorder so that you can seek treatment if necessary. 

Symptoms of a speech disorder

• Elongating words
• Quiet or muffled speech
• Blinking frequently
• Distorted sounds while talking
• Frequent changes in pitch
• Poor voice quality
• Visible frustration when trying to communicate
• Overall difficulty communicating and expressing thoughts and ideas
• Inability to repeat words
• Inability to pronounce words the same way twice
• A phobia of speaking in public
• Speaking slowly and carefully
• Speech delay
• Frequent pauses when talking
• Limited vocabulary over several years, delayed language development

Some speech and language disorders are consistent with underlying mental health conditions such as autism. You can visit licensed health professionals or speech therapists to receive an accurate diagnosis and find out how to treat a speech impediment or language disorder, and its underlying cause, if applicable.

Categories of a speech disorder

Speech impediments or communication disorders can take many forms, from speech sound disorders to voice-related disorders. While speech sound disorders mostly result from sensory or motor causes, voice-related disorders deal with physical problems regarding speech. Read on for a list of some of the most common categories of speech impediments.

Voice disorders

Voice disorders  primarily arise due to issues regarding the health and structure of the larynx or the voice box. They can impact pitch, resonance, volume, and voice quality. Symptoms of a voice disorder may include having a hoarse, quivering, strained, choppy, or weak and whispery voice, which can make it difficult to produce speech sounds.

The root cause of these disorders can be either organic, like alterations to respiratory, laryngeal, or vocal tract mechanisms, or functional, like improper use of the voice. Some risk factors that may contribute to vocal health challenges include allergies, psychological stress, age, excessive alcohol or drug use, screaming, scarring from neck surgery, or even gastroesophageal reflux disease (GERD). Examples of voice disorders include laryngitis, vocal cord paralysis/weakness, polyps or nodes present on the vocal cords, leukoplakia, or muscle tension dysphonia.

Fluency disorders

A person may be diagnosed with a fluency disorder if they have trouble with speech timing and rhythm which makes it difficult to create a normal speech pattern. These disorders are characterized by interruptions in the typical flow of speaking, including abnormal repetitions, hesitation, and prolongations. Their cause is unknown, but it may be genetic. Symptoms can also be exacerbated by stress and anxiety. Stuttering is the most common example of fluency disorders. 

Symptoms of a fluency disorder may include dragging out syllables, speaking breathlessly, repetition of words, speaking slowly, and being tense while speaking. Secondary symptoms may include fidgeting, mumbling, saying “um” or “uh” often, not using certain problematic words, rearranging words in sentences, and anxiety around speaking. Treatment options vary depending on the specific disorder. With stuttering, for example, slowing down, practicing, using speech monitors, attending speech therapy, and receiving cognitive behavioral therapy (CBT) are all potential treatment options.

Articulation disorders and phonological disorders

Articulation and phonological disorders are two types of speech disorders classified as speech sound disorders that may impact communication. An articulation disorder includes speech that commonly exhibits errors such as substitution, omission, distortion, and/or addition (SODA). Although the actual causes of articulation disorders aren’t well understood, contributing factors may include brain injuries, a cleft palate/cleft lip, or nerve damage. Phonological disorders typically involve producing sounds correctly but using them in the wrong place and are more predictable than articulation errors. There may also be a genetic factor that contributes to both disorders and other families may be impacted as well. A licensed speech-language pathologist (SLP) can determine if an individual may have an articulation disorder or a phonological disorder. Ongoing speech therapy is typically the recommended treatment method.

Speech impediments versus language impairments

A speech impediment is typically characterized by difficulty creating sound due to factors like fluency disorders or other voice problems. These disorders may arise from underlying mental health issues, neurological problems, or physical factors or conditions impacting speech muscles.

Language impairments, on the other hand, are more about difficulty processing, reading, and writing and can be connected to an issue processing receptive language. They’re common in children, especially when they first start school. Language impairments relate to meaning, whereas speech impediments relate to sound. It’s also very common for a language impairment disorder to present alongside a learning disability like dyslexia.

An example of speech disorder: Apraxia

Apraxia of speech is a speech sound disorder that affects the pathways of the brain. It’s characterized by a person having difficulty expressing their thoughts accurately and consistently. It involves the brain being able to form the words and knowing exactly what to say, but the person then being unable to properly execute the required speech movements to deliver accurate sounds. In mild cases, a person will only have small limitations in their ability to form speech sounds. In severe cases, alternate communication methods may need to be used.

An SLP is the type of provider who can diagnose apraxia. To diagnose speech disorders, including both childhood apraxia (sometimes called verbal apraxia) and acquired apraxia, they may ask the individual to perform simple speech tasks like repeating a particular word several times or repeating a list of words that increase in length. Apraxia generally needs to be monitored by both parents and an SLP over time for an accurate diagnosis to be possible.

There are various treatment options for apraxia, the most common being one-on-one meetings with a speech pathologist. They’ll likely help you or your child build helpful strategies and skills to help strengthen problem areas and communicate more clearly. Some other treatment methods include improving speech intelligibility or using alternate forms of communication, like electronic speech or manual signs and gestures.

An example of communication disorder: Aphasia

The National Institute on Deafness and Other Communication Disorders describes aphasia as a communication disorder that results in a person’s inability to speak, write, and/or understand language. Like other communication disorders, it may occur because of damage to the portions of the brain that are involved in language, which is common in those who have experienced a stroke. It may also come on gradually in those who have a tumor or a progressive neurological disease like Alzheimer’s. Symptoms may include saying or writing sentences that don’t make sense, a reduction in a person’s ability to understand a conversation, and substituting certain sounds and words for others.

Brain injuries in patients with Aphasia

Since this disorder is usually caused by damage to parts of the brain, it will typically first be recognized in an MRI or CT scan that can confirm the presence of a brain injury. The extent and type of aphasia can generally only be determined by observing the affected part of the brain and determining how extensively it has been damaged, which is often done with the help of an SLP.

Treatment options for aphasia can be restorative (aimed at restoring impaired function) or compensatory (aimed at compensating for deficits).

An example of nervous system disorder: Dysarthria 

Dysarthria is usually caused by brain damage or facial paralysis that affects the muscles of the jaw, tongue, or throat, which may result in deficits in a person’s speech. It may also be caused by other conditions like Lou Gehrig’s disease, Parkinson’s, or a stroke. It’s considered a nervous system disorder, subclassified as a motor speech disorder. It’s commonly seen in those who already have other speech disorders, such as aphasia or apraxia. Symptoms of dysarthria include slurred speech, speaking too slowly, speaking too quickly, speaking very softly, being unable to move one’s lips or jaw, and having monotonous speech.

Exercises to counter muscle weakness

Dysarthria can be diagnosed by an expert in speech-language pathology through an exam and tests like MRI, CT, electromyography, or the Denver articulation screening examination. Treatment depends upon the severity and rate of progression of the disorder. Some potential examples include tactics like slowing down while talking, doing exercises to help strengthen jaw muscles, moving the lips and tongue more, and learning strategies for speaking more loudly. Hand gestures and speech machines may also help. 

Seek treatment if you’re having difficulty with verbal communication

It is important to treat speech disorders; the consequences of an untreated speech or language impediment can vary widely depending on the type, symptoms, and severity, as well as the age and life situation of the individual. In general, it’s usually helpful to seek professional advice on treating speech disorders as soon as you notice or suspect an impediment present in yours or your child’s speech. Especially for moderate to severe cases, some potential effects of leaving these common speech disorders untreated can include:

• Poor academic performance/dropping out of school
• Decrease in quality of life
• Social anxiety and an inability to connect with people
• Damaged relationships
• Social isolation
• Hospitalization

Support options and resources

Meeting with an SLP is usually the recommended first step for someone who believes they or their child may have a speech impediment. If you have a teenager with dyslexia, there are  resources for dyslexic teens  that can give supportive information about the condition. Healthcare providers may also provide helpful insights and ask about your family members’ history when it comes to speech and language-related issues as they can be hereditary.

Therapeutic support for speech impediments

While these professionals can help with the physical aspects of a variety of speech and language impediments, you or your child may also benefit from emotional support in relation to the mental health effects of having an impediment. A therapist may be able to provide this type of guidance. If your child is experiencing a speech impediment, a counselor may be able to work with them to process their feelings of frustration and learn healthy coping mechanisms for stress. They can help you manage the same feelings if you receive a speech or language impediment diagnosis, or may be able to support you in your journey of parenting a child with a speech or language impediment diagnosis.

In addition to support at home, teenagers with a diagnosed speech impairment or impediment can receive special education services at school. The Centers for Disease Control notes that under the Individuals with Disabilities Act (IDEA) and Section 504, schools must provide support and accommodations for students with speech disorders. For some children, support groups can provide outlets for social connections and advice for coping. 

Accessible healthcare options online

Meeting with a therapist in person is an option if there are providers in your area. That said, many people find it less intimidating or more comfortable to meet with a therapist virtually. For example, a teen who is experiencing a speech or language impediment may feel better interacting with a counselor through the online chat feature that virtual therapy platforms like TeenCounseling provide. It may allow them to express themselves more clearly than they could face-to-face or over the phone. Parents who need support in caring for a child with a speech or language impediment may find the availability and convenience of meeting with a therapist through an online therapy service like BetterHelp to be most beneficial. Research suggests that online and in-person therapy offer similar benefits for a variety of conditions, so you can choose the format that’s best for you.

Counselor reviews

See below for reviews of TeenCounseling therapists written by parents who sought help for their children through this service. 

“Kathleen has been good for my daughter to talk to. I am thankful for her to give my daughter someone else's perspective other than her parents. Thank you.”

“I love Ms. Jones. She doesn’t over-talk or judge you. She gives really good advice and if you're confused she knows how to break it down or explain whatever it is so you can understand. If you need to talk about anything, she’s always an open ear and responds quickly. Not only does she give you points from others' perspectives but she steps into yours so she can understand why certain things are the way they are. In my first session, I was nervous and I think she could tell. She’ll crack a joke every now and then to make me feel more comfortable. She’s just such a bundle of joy and a good counselor to have.”

Speech and language impediments can vary widely in terms of types, causes, symptoms, and severity. These are diagnosed by professionals in the field of speech and language pathology or by a medical doctor. A therapist can provide emotional support for those who are having difficulty coping with their own or their child’s diagnosis or other related challenges. 

What are the 3 speech impediments?

Speech impediments can manifest in a variety of ways. Three of the most common are listed below: 

• Voice disorders affect the tone, pitch, quality, and volume of a person’s voice. A person with a voice disorder may have difficulty speaking or being heard clearly by others. Voice disorders can be either functional or organic. Functional disorders occur due to improper use of the parts of the throat that produce speech, such as overuse of the voice leading to vocal fatigue. Organic voice disorders result from physical anatomical changes, such as nodules on the vocal cords. 
• Fluency disorders affect the rate, rhythm, and cadence of speech. Those with fluency disorders may speak in a disjointed, choppy, or prolonged fashion, making them difficult for others to understand clearly. While many types of fluency disorders exist, stuttering is likely the best-known. Speech often requires precise timing to convey a message accurately, which fluency disorders can disrupt. 
• Speech sound disorders are a broad category of disorders that interferes with a person’s ability to produce sounds and words correctly. Speech sound disorders can present very differently from person to person. Sometimes word sounds are omitted or added where not appropriate, and sometimes word sounds are distorted or substituted completely. A typical example of a speech sound disorder is the substitution of “r” for “w” in words like “rabbit” (becoming “wabbit”). Many children experience that substitution, but it does not become a disorder until the child does not outgrow it. 

Other types of disorders can cause problems with expressive communication or tongue-tie those experiencing them, such as developmental language disorder. Language disorders also cause concerns related to expressive communication, but the concerns are due to a lack of understanding of one or more components of language, not an inability to produce or use word sounds. 

What do you call a speech impediment?

Speech impediments are typically referred to as speech disorders . Speech refers to the ability to form speech sounds using the vocal cords, mouth, lips, and tongue. Speech also requires that a rhythm and cadence be maintained. Speech disorders indicate a problem producing intelligible speech; word sounds may be omitted or misplaced, the rhythm of the speech may be difficult to follow, or a person’s voice might be strangely pitched or too soft to hear clearly. 

It is important not to confuse speech disorders with language disorders . Language disorders arise due to difficulty understanding what words mean, how word sounds fit together, or how to use spoken language to communicate. Language problems may affect how a person speaks, but the root cause of the concern is linked to their understanding of language, not their ability to produce intelligible speech. 

How do I know if I have a speech impediment?

If you’re experiencing a sudden onset of impaired speech with no apparent cause, seek medical attention immediately. Strokes, traumatic brain injuries, and other serious medical conditions can cause sudden changes in speaking ability. Gradual changes in speaking ability may also indicate an underlying medical problem. If you’re concerned that your speaking ability has been gradually deteriorating, consider making an appointment with a healthcare provider in the near future. 

Most people with a speech disorder are diagnosed in childhood. Parents often identify speech-related concerns in early childhood based on their child’s speech patterns. The child’s pediatrician may also refer the child to a speech-language pathologist, a professional specializing in evaluating and treating speech disorders. If problems persist until the child is in school, teachers and other school officials might initiate a referral for an evaluation if they believe speech concerns are present. Children often receive speech and language therapy that resolves or improves their speech problems. 

Speech disorders also appear in adulthood, often due to injury or illness. It is also possible, although rare, for speech problems to be misdiagnosed or missed outright during a person’s childhood. In that case, the speech disorder may have been present since childhood and symptoms persisted into adulthood.

If you’re finding it difficult to communicate verbally with others, have an easily identifiable speech problem (like stuttering), or receive feedback that others have trouble understanding you, consider making an appointment with your doctor for an evaluation and referral to the appropriate healthcare providers. 

What are 5 causes of speech impairment?

Speech and language disorders can result from conditions that interfere with the development of perceptual, structural, motor, cognitive, or socioemotional functions. The cause of many speech disorders is unknown, but research has indicated several underlying factors that may be responsible: 

• Pre-existing genetic conditions, like Down’s syndrome or Fragile X syndrome. Evidence suggests that genes may play a role even if genetic abnormalities do not result in a diagnosable genetic condition. 
• Physical abnormalities, such as damage or improper development of the respiratory system, facial muscles, or cranial nerves. 
• Hearing problems, which can delay a child’s acquisition of speech. 
• Neurodevelopmental disorders, such as autism spectrum disorder, may interfere with speech development. There is also evidence to suggest that those with attention-deficit hyperactivity disorder may have a more challenging time acquiring speech skills. 
• Neurological conditions such as cerebral palsy. 

Mental health concerns can also cause problems communicating with others. For example, an underlying anxiety disorder may lead to selective mutism , wherein a child speaks only under certain circumstances. 

Is speech impediment a disability?

A speech-language disorder is considered a “ communication disability ” under the Americans with Disabilities Act (ADA). The ADA requires government and businesses to establish “effective communication” with people who have communication disabilities. Effective communication can be established in several ways. For those with a speech disorder, accommodation may be as simple as ensuring the person can get hold of writing materials if they need to express themselves quickly. In some cases, organizations may use a transliterator, or person trained to recognize unclear speech and repeat it clearly. 

Because speech disorders are known to lead to academic struggles in K-12 and higher education settings, they are categorized as a disability under the Individuals with Disabilities Education Improvement Act (IDEIA) . The IDEIA sets guidelines for all schools in the United States, public or not public, guaranteeing each child a right to accommodations and interventions for their speech disorder. 

Can I fix my speech impediment?

Whether or not a speech disorder can be completely eliminated depends heavily on individual factors. The cause of the disorder, its severity, and the type of speech dysfunction all play a role in determining whether a particular disorder can be completely resolved. While it is not possible to guarantee that a speech disorder can be “cured,” nearly all disorders are treatable, and improvement is likely possible. 

Can you treat a speech impediment?

Yes, many speech disorders are highly treatable. Most people receive treatment as children when most speech disorders become apparent. For children, speech-language pathologists will identify the specific speech disorder, search for an underlying cause, and design an intervention that targets that child’s speech problem. For example, a child who struggles with articulation errors and producing word sounds consistently may benefit from a contextual utilization approach . Contextual utilization leverages the fact that one sound is easier or more difficult to pronounce depending on which other sounds surround it. 

Speech disorders that emerge in adulthood may be more challenging to treat due to underlying factors, such as brain injury. Suppose an adult experiences a traumatic brain injury that affects their speaking ability. In that case, a speech-language pathologist may help them find alternative communication methods, such as using a computer. They may also help them directly restore some of their speaking ability by leading them through exercises that improve nerve function and muscle control.  

Is a speech impediment mental?

Speech disorders can be caused by various factors, many of which have nothing to do with the brain. However, there is a relationship between psychiatric mental health concerns and difficulty with spoken communication . Although researchers are still unsure of the exact cause, studies have identified a significant link between speech disorders and mental health disorders like schizophrenia, bipolar disorder, and major depression. 

Neurodevelopmental disorders, such as autism spectrum disorder and attention-deficit hyperactivity disorder, are also associated with an increased risk of developing a speech disorder. Although the link between neurodevelopmental disorders and speech disorders is not fully understood, evidence suggests that treating the speech disorder is still possible. 

Finally, speech disorders can also be caused by illness or injury in the brain, such as cancer, an infection, or traumatic brain injury. Although these are not considered mental or developmental disorders, they may affect brain function and mental acuity. Speaking is a complex process, and there are many ways it can be affected. 

Is autism a speech impediment?

Autism spectrum disorder is not a speech disorder, but it is heavily associated with communication problems. Those on the autism spectrum often use repetitive or rigid language and may not follow communication norms. They may repeat phrases continuously, use a modified tone of voice, or introduce information that has little to do with the conversation at hand. 

Those on the autism spectrum are often able to form word sounds properly. The communication deficits of autism spectrum disorder are more closely related to language disorders than speech disorders. Speech disorders are associated with difficulty producing or using word sounds correctly, whereas language disorders are associated with a lack of understanding of one or more language components.

Autism spectrum disorder is also characterized by difficulties using pragmatic communication, or communication that is appropriate to a specific social situation. Although not a disorder of speech, a limited ability to recognize the socioemotional content of speech can significantly impact interpersonal communication and social interactions. 

• Navigating Depression In Teens And Young People Medically reviewed by Elizabeth Erban , LMFT, IMH-E
• ADHD Signs In Women, Men, And Children Medically reviewed by Julie Dodson , MA, LCSW
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• v.10(6); 2008

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood

Patricia a. prelock.

Department of Communication Sciences, University of Vermont, Burlington, Vermont

Tiffany Hutchins

Frances p. glascoe.

Department of Pediatrics, Vanderbilt University, Nashville, Tennessee

Disclosure: Tiffany Hutchins, PhD, has disclosed no relevant financial relationships in addition to her employment.

Disclosure: Frances P. Glascoe, PhD, has disclosed no relevant financial relationships in addition to her employment.

Abstract and Introduction

Speech-language problems are the most common disability of childhood yet they are the least well detected, particularly in primary care settings. The goal of this article is to: (1) define the nature of speech-language problems, their causes, and consequences; (2) facilitate early recognition by healthcare providers via accurate screening and surveillance measures suitable for busy clinics; and (3) describe the referral and intervention process.

Introduction

Speech-language deficits are the most common of childhood disabilities and affect about 1 in 12 children or 5% to 8% of preschool children. [1] The consequences of untreated speech-language problems are significant and lead to behavioral challenges, mental health problems, reading difficulties, [2] and academic failure including in-grade retention and high school dropout. [3] Yet, such problems are ones that are least well detected in primary care, [4] even though intervention is available and plentiful.

Speech-language impairments embrace a wide range of conditions that have, at their core, challenges in effective communication. As the term implies, they include speech disorders which refer to impairment in the articulation of speech sounds, fluency, and voice as well as language disorders which refer to impairments in the use of the spoken (or signed or written) system and may involve the form of language (grammar and phonology), the content of language (semantics), and the function of language (pragmatics). [5] These may also be described more generally as communication disorders which are typically classified by their impact on a child's receptive skills (ie, the ability to understand what is said or to decode, integrate, and organize what is heard) and expressive skills (ie, the ability to articulate sounds, use appropriate rate and rhythm during speech, exhibit appropriate vocal tone and resonance, and use sounds, words, and sentences in meaningful contexts). There are common conditions in infants, toddlers, and preschoolers that are associated with receptive and expressive communication challenges as presented in Table 1 . [6 – 17]

Disorders in Young Children Commonly Associated With Receptive and Expressive Communication Problems

It is important to distinguish speech and language impairment from language delay and language difference. Language delay is characterized by the emergence of language that is relatively late albeit typical in its pattern of development. In contrast to an impairment or a delay, a language difference is associated with systematic variation in vocabulary, grammar, or sound structures. Such variation is “used by a group of individuals [and] reflects and is determined by shared regional, social, or cultural and ethnic factors” and is not considered a disorder. [18]

Unfortunately, non-native speakers of English, speakers of various dialects (whose language also varies within dialect), and bilingual or multilingual speakers are frequently classified as language delayed or disordered when, in fact, they are language different [18 , 19] –although problems of underidentification also occur. This is particularly important in an increasingly pluralistic society such as ours in which 1 of 4 people identify as other than white non-Hispanic, approximately 17% of the population is bilingual (mostly speaking Spanish and English), and where minorities represent more than 50% of the population in several cities and counties. [20]

The overidentification of culturally and linguistically diverse populations commonly occurs when a mismatch is observed and incorrectly interpreted between a language used in a particular community and that of the majority culture. This may be seen most clearly in the improper use of formal tests of speech and language to assess the competencies of speakers who are dissimilar to the sample upon which the test was normed and developed. [21] Similar errors also occur during informal evaluations of language and literacy as when the sound structure of the language influences the spelling or grammatical conventions used in written discourse. [22] With regard to bilingualism, it is commonly assumed that children's acquisition of 1 or both languages is delayed; however, the effects of bilingualism are more complex and differ with the age of the child, the nature of the linguistic input, and the manner and timing of language acquisition. What is clear is that equivalent proficiency in each language should not be expected or assumed as this has the potential to lead to misidentification of a speech and language impairment. (For more information on the effects of bilingualism on language learning, see http://asha.org/public/speech/development/BilingualChildren.htm and http://asha.org/public/speech/development/second.htm ) In the case of culturally and linguistically diverse individuals, decisions to intervene and bring language use in line with that of the majority culture or promote proficiency in the dominant language are not inappropriate; however, such decisions must be seen as separate from the language difference vs disorder question.

In your experience, which of the following is the most important barrier to the effective assessment of speech and language impairment in young children? (Select only 1 answer.)

• ○ Variability in the development of speech and language in young children
• ○ Lack of effective screening tools that discriminate children with and without speech and language impairment
• ○ Lack of accurate parent interview tools that identify clear concerns in speech and language development
• ○ Insufficient time with young children in the clinical setting to observe speech and language skills
• ○ Inadequate understanding of milestones for speech and language development

How confident are you that you are up-to-date in the diagnosis and management of speech and language impairment in young children? (Select only 1 answer.)

• ○ Not at all confident
• ○ Somewhat confident
• ○ Confident
• ○ Very confident

All of the following statements about young children with speech and language impairment are true except :

• ○ Young children tend to produce words with sounds that are consistent with the words they already know
• ○ Young children are able to communicate intent before speaking their first words
• ○ Disfluency is a common occurrence in a young child's early speech
• ○ Children usually begin to put 2 words together at 30 months

Answer: Children usually begin to put 2 words together at 30 months. Children usually begin to put 2 words together at 18 months.

Etiology, Neurobiology, and Prevalence of Speech-Language Impairments

The etiology of most cases of speech-language impairments is unknown but diverse causes are suspected. The range of causes or origins includes anatomical abnormalities, cognitive deficits, faulty learning, genetic differences, hearing impairments, neurologic impairments, or physiologic abnormalities. [6] As noted above, language differences as revealed in the communication output associated with diverse cultural, ethnic, regional or social dialects are not considered disorders. [5] Speech and language impairments may be acquired (ie, result from illness, injury or environmental factors) or congenital (ie, present at birth).

Children with speech and language impairment are an under-representation of the broader occurrence of communication disorders, [23] especially considering the co-occurrence of communication disorders with other disabilities (eg, learning disabilities). Approximately 8% to 12% of preschool populations exhibit language impairments. [6] Among children enrolled in early intervention programs, 46% have communication impairments while 26% have developmental delays in multiple areas, usually including language skills. [24] These findings indicate that the most common presentation of disability in preschoolers involves problems with language.

In a family with a child with a speech and language impairment, which of the following would be clinically appropriate?

• ○ Reassure the parents that the child is just a late talker and will catch up
• ○ Urge the parents to have their child undergo genetic testing
• ○ Discourage the child's parents and sibling(s) from talking for the child as this may be a primary cause of a speech and language impairment
• ○ Advise the parent to have the child's hearing tested

Answer: Advise the parent to have the child's hearing tested. This is appropriate because hearing would be the first condition to rule out as a potential cause of a speech and language delay.

Course and Prognosis

Speech-language impairment sometimes emerges during infancy with challenges in response to sound, atypical birth cries, or limited response to others and progresses through the toddler and preschool age with limited comprehension of spoken language and difficult interactions with peers and others as well as delays in producing first words and word combinations. Speech and language difficulties often persist in school age with difficulties following directions, attending and comprehending oral and written language, and problems producing narratives and using language appropriately in social contexts. Parents are often the first to notice difficulties as they encounter other children with more advanced speech-language skills and thus often wonder if their child is behind. [25] Although many parents raise concerns to primary care providers, many do not. In turn, primary care providers who do not use quality screening tools often dismiss parental concerns with panaceas such as, “He's a boy. Boys talk later.” Or, “Let's give this some time and see if it continues.” Yet, parental concerns about speech and language are associated with developmental disabilities [26] and, thus, careful screening with accurate tools is the requisite response. [27]

The use of a “wait and see” approach underscores the difficulty in distinguishing children who are language delayed from those who have a speech and language impairment. Although most children who have aspeech and language impairment have a history of language delay, only one quarter to one half of late-talkers are eventually diagnosed with a language disorder. [19] In advocating for a more aggressive response for late-talking children, some have argued for careful scrutiny of other risk factors that may guide decisions to refer and intervene. [19] Predictors of a true speech and language impairment that should be considered include poor receptive language skills, [28] limited expressive language skills (eg, small vocabulary, few verbs), and limited development in the sound structure of a language (eg, limited number of consonants, limited variety in babbling structure, vowel errors). [26] Additional predictors include nonspeech (eg, behavioral problems, few gestures, little imitation or symbolic play), environmental (eg, low socioeconomic status, parental use of a directive rather than sensitive and responsive interactional style), and hereditary factors (eg, family history). [26] As a general recommendation, professionals are urged to consider a larger number of risk factors with greater concern. [26]

Often speech-language impairments can be difficult to distinguish from what is considered typical variations in speech and language. For example, disfluencies in speech may be either normal or abnormal. In the nonstuttering child, the most common disfluencies include 1-unit word repetitions (eg, “I… I want that”), interjections (eg, “I saw a… um… picture”), and revisions (eg, “I don't know where… Mommy, help me find my doll”) and, when combined, comprise no more than 10% of words spoken. [29] In the stuttering child, the fluency disorder typically emerges between the ages of 2 and 5 years, is more common among males than females, and is characterized by more than 10% disfluencies in speech, multi-unit syllable (eg, “s-s-s-s-s-September”) and word (eg, “That's my-my-my ball”) repetitions, and may be accompanied by secondary behaviors such as eye-blinking, head-bobbing, or grimacing, as well as feelings of frustration or embarrassment surrounding the stuttering event. [29]

Identification of speech and language impairments is further complicated by the fact that they often masquerade as other diagnostic conditions. For example, children with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) may in fact have an underlying language disorder. Differential diagnosis is challenged by the diagnostic criteria shared between the 2 conditions. Specifically, the diagnostic criteria for ADHD share several characteristics with language disorders including difficulty listening when spoken to, following instructions, talking excessively, blurting out answers, interrupting, and waiting for turns in conversation. [30] Similarly, 50% of preschoolers presenting for psychiatric services were found in several studies to have undiagnosed language impairment. [31 , 32]

The diagnostic criteria for speech-language impairments are defined both by the Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV) [33 , 34] and by the Individuals with Disabilities Education Act (IDEA) through the US Department of Education. Table 2 specifies the criteria for communication disorders as described in the DSM-IV. As an example of eligibility criteria for speech-language impairment in response to IDEA guidelines, Vermont indicates that children must demonstrate significant deficits greater than 2 standard deviations below the mean in listening comprehension (eg, measures of auditory (language) processing or comprehension of connected speech including semantics, syntax, phonology, recalling information, following directions and pragmatics) and/or oral expression (eg, measures of oral discourse-syntax, semantics, phonology and pragmatics; voice; fluency; articulation) to qualify as speech or language impaired. [35]

Characteristics of Communication Disorders as Described in the DSM-IV [33 , 34]

Distinguishing children with speech-language deficits from those with other disabilities is often a challenging task as several disabilities share characteristics and have similar diagnostic criteria. For example, an intellectual disability is one in which a child's performance falls at or below 1.5 standard deviations from the mean on a test of intellectual ability with concurrent deficits in adaptive behavior. Children with intellectual disabilities, however, often have significant challenges in receptive and expressive communication as is typical of children with speech and language impairments. Children with learning disabilities have deficits in 1 or more basic skill areas including oral expression and listening comprehension, challenges characteristic of children with speech-language impairments. Children with pervasive developmental disorders/autism exhibit marked impairments in communication and social interaction and restricted and repetitive stereotyped patterns of behavior. Although social impairment is a defining feature of autism, communication impairments are similar to those with a speech-language impairment.

Which of the following is not true of speech-language impairment?

• ○ Early intervention is critical as speech-language impairments place children at risk for later academic difficulties
• ○ Most children with speech-language impairments have intellectual deficits
• ○ Communication disorders may manifest themselves at different stages of life
• ○ Children with learning disabilities are likely to have speech and language impairments

Answer: Most children with speech-language impairments have intellectual deficits. Although many children who have mental retardation have speech-language impairments, most children with specific speech-language impairments have nonverbal intelligence within normal limits.

Screening and Early Assessment of Speech-Language Disorders

The American Academy of Pediatrics recommends ongoing surveillance and periodic use of broad-band screening measures at all well-visits. Table 3 provides information on a number of tools that have high levels of accuracy in detecting speech-language problems and other disabilities. All included measures were standardized on national samples, proven to be reliable, and validated against a range of measures. When used, referral rates to early intervention programs rise to meet prevalence. [36] In the absence of accurate measures, most providers rely on informal milestone checklists. These lack criteria and are probably the leading reason why only about 1 in 4 children with disabilities of any kind are referred for needed assistance.

Accurate Developmental, Mental Health/Behavioral, and Academic Screens Suitable for Primary Care *

© 2007, Glascoe FP. PEDS: Developmental Milestones Professionals Manual. Nashville, Tennessee: Ellsworth & Vandermeer Press, Ltd. Permission is given to reproduce this table.

The first column in Table 3 provides publication information and the cost of purchasing a specimen set. The “Description” column provides information on alternative ways, if available, to administer measures (eg, waiting rooms). The “Accuracy” column shows the percentage of patients with and without problems identified correctly. The “Time Frame/Costs” column shows the costs of materials per visit along with the costs of professional time (using an average salary of $50 per hour) needed to administer and interpret each measure. Time/cost estimates do not include expenses associated with referring. For parent report tools, administration time reflects not only scoring of test results, but also the relationship between each test's reading level and the percentage of parents with less than a high school education (who may or may not be able to complete measures in waiting rooms due to literacy problems and will need interview administrations).

Even when screens are deployed, it is nevertheless helpful to complement these brief measures with clinical observation. The brevity of screens useful for primary care means that some skills may not be captured. For example, at any given age range, a brief screen may not present articulation items, measure ability to repeat a story, describe daily events, ask questions, or engage in conversation, etc. The value in routinely administering validated, accurate screening tools, however, is essential to improving currently problematic and extremely low rates of early detection on the part of primary healthcare providers.

Table 4 describes some major language developmental milestones in the prelinguistic (birth to 1 year) and linguistic period (1 year and beyond). [37 , 38] It is important to note that there are wide variations in the speed (and style) with which typically developing children acquire language skills.

Average Age and Range of Ages for Achievement for Important Language Developmental Milestones * [37 , 38]

Providers are reminded that these indicators are an aid to early detection but do not substitute for quality measurement. See Table 3 for a list of screening measures with proven accuracy.

Screening for Other Potential Contributors to Speech-Language Deficits

Another critical avenue for exploration into possible contributors to speech-language deficits is psychosocial risk. Parents who are depressed and/or have housing or food instability have children more likely to have language problems, perhaps because parents lack the energy and freedom from preoccupations to engage in the kinds of language-mediated social interactions known to support optimal child language development. Some parents are not aware of positive parenting practices that promote development, especially language skills (eg, talking with and reading to their child, creating opportunities for sustained dialogue, responding contingently to a child's initiations). Detecting and intervening when psychosocial risk factors, including abuse and neglect, are present has the potential to prevent language problems from developing. Screens for psychosocial risk factors including depression and parent-child interactions are widely available and include the Family Psychosocial Screen and the Brigance Parent-Child Interactions Scale . Both are included in PEDS: Developmental Milestones [39] as supplementary measures helpful for surveillance and offer evidence-based compliance with recommendations in early detection from the American Academy of Pediatrics. [40] , Many other screens, such as the Ages and Stages Questionnaire , include a background information questionnaire that captures common psychosocial risk factors. [41]

Screening Older Children

With school-age children, obtaining and reviewing group achievement test scores can help reveal undiagnosed language deficits. Such children typically have weaknesses in general information (eg, science, social studies knowledge), problems with reading comprehension, and sometimes also problems with math concepts. Table 3 also includes screens suitable for primary care professionals working with children aged 8 years and older.

For both preschoolers and school-age children, broad-band screens (or review of group achievement test results) should be deployed first and serve as a guide to the selection of narrow-band instruments. For example, attentional deficits can be due to a range of conditions such as language impairment, learning disabilities, and mental health problems such as depression. The optimal approach is to administer a broad developmental or academic screen along with a measure such as the Pediatric Symptom Checklist (which discriminates mental health from attentional difficulties). Only afterward and as suggested by the results of broad-band measures should a narrowly focused tool such as the Vanderbilt ADHD Diagnostic Rating Scale be administered. Making sure that other conditions are treated first or at least concomitantly with ADHD is essential.

Billing and Coding for Screening

Primary care providers can use the – 25 modifier to their preventive service code (to indicate that stand-alone services were offered and then use 96110 times the number of screens administered, eg, 96110 X 2. For insurers not accepting units, the distinct procedural service of each screen is best represented with the – 59 modifier appended to each additional unit of 96110.

In 2005, the Centers for Medicare and Medicaid Services published a total relative value unit (RVU) of 0.36 for 96110, which amounts to a Medicare payment of $13.64. None of this can guarantee that a valid claim will be accepted, so the American Academy of Pediatrics is willing to help with denied claims via their Coding Hotline: 800-433-9016, x4022, or at .gro.paa@eniltohgnidocpaa RVUs do not cover physician time, so making use of office staff and parent-report tools is essential.

Referrals and Other Interventions

Once suspicion exists that a child may have a speech-language impairment, referral to early intervention or to the public schools (depending on age) is the first step. These programs offer intervention by speech-language pathologists. If sufficient quantity is not available, referrals can also be made to private therapy services, which may be covered by the patients' insurance. If there appear to be underlying medical conditions, assessment by other disciplines, such as developmental-behavioral or neurodevelopmental pediatrics, is important.

For families with psychosocial risk factors, developmental promotion is essential as is careful monitoring of progress. If brief advice and information handouts are not effective and particularly if children have delays not sufficiently great as to qualify for services, then parent training, quality day care, Head Start, after-school tutoring, and private speech-language therapy should be recommended. Table 5 shows a list of professional development and referral resources. Table 6 provides a list of resources and information for parents.

Professional Development and Referral Resources

Resources and Information for Parents

Components of a Diagnostic Evaluation of Speech-Language Impairment and the Nature of Interventions

Although screening tools for speech-language often identify those children who have speech-language impairments, a screening is not a diagnostic evaluation and only suggests a child requires a more comprehensive assessment. There are several goals in a diagnostic assessment, including verifying that a speech-language impairment exists, describing the strengths and challenges of the child's speech and language, evaluating the severity of the problem, ascertaining the etiology, determining recommendations for a treatment plan, and providing a prognosis. [6] Assessment requires obtaining a sample of communication skills across settings through a number of procedures. It is critical to collect information not only from standardized, formal tools but also to gather more authentic, real-life information to facilitate meaningful and accurate decisions. Typically, case history information, parent interviews, checklists from other providers, systematic observation, hearing screening, and examination of the speech mechanism is included. [6] Formal norm-referenced tests are used to assess articulation, phonology, grammatical understanding and production, and pragmatic language use. The collection of data from the authentic assessment tools and the formal measures provide a comprehensive picture of the speech-language needs of a young child with a communication impairment.

All of the following are true in the assessment of a young child with speech-language impairments except :

• ○ Obtaining information from multiple sources across settings is necessary to specify communication strengths and challenges
• ○ Speech-language pathologists (SLPs) make diagnoses of specific speech-language impairment, identify probable causes, determine severity, describe the likely prognosis, and provide recommendations
• ○ Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment
• ○ During assessment, speech, language, hearing, and processing abilities should be probed

Answer: Clinical judgment is most appropriate for determining the severity of a child's speech-language impairment. Objective criteria are important to ensure consistency in the assessment of severity.

To determine the prognosis for a young child with a speech-language impairment, which of the following is true?

• ○ A clinician should avoid providing prognostic information, as questions like “Will my son outgrow his speech-language impairment?” cannot be answered
• ○ Trial therapy during an assessment period is an appropriate strategy to inform prognosis
• ○ Families and clinicians have little difficulty making decisions about whether or not a young child with early expressive language delay will benefit from therapy
• ○ Single evaluation measures can be used to determine the severity of a young child's speech-language impairment and the prognosis for successful outcomes

Answer: Trial therapy during an assessment period is an appropriate strategy to inform prognosis. Clinicians often probe a child's response to intervention strategies to determine responsiveness to treatment and to inform the development of the treatment plan.

Intervention Approaches and Outcomes

The complexity of impairments in speech and language requires a variety of intervention approaches that can address deficits in language form (syntax, phonology, morphology), language content (semantics), and language use (pragmatics) as well as speech and voice production. Further, intervention for young children may involve not just the speech-language pathologist but also care providers and peers.

The ultimate goal of intervention is to increase a child's success in using language to communicate his or her intent, respond to the intent of others, and participate in reciprocal interactions. The speech and language targets vary for each child depending on the context and aspects of communication affected. Targets may or may not follow a strict developmental approach. Sometimes a more functional approach is appropriate, supporting communication at the point of frustration and breakdown. [6] Intervention targets should consider the family's desired outcomes for their child's communication. Targets should be developmentally appropriate and meaningful to the child.

Several teaching methods are used to support the speech and language of children. Modeling is a typical intervention strategy that provides focused stimulation on the speech or language targets selected for an individual child. Cueing is another frequently used technique that includes direct and indirect verbal cues (eg, asking a child to imitate a sound, word, or utterance) or nonverbal cues (eg, giving a child a jar with a desired item that can't be opened without help). In addition, responding to a child's communication efforts through reinforcement or corrective feedback (eg, “Remember to say the ending sound /t/ so we know you mean the word ‘boat’”) is frequently used to facilitate effective communication. [6]

Case Studies

Bobby [pseudonym] is a 7-year-old boy whom you have seen in your office for a number of years. He comes to you today for his annual check-up. Bobby is enrolled in the second grade. His mother is concerned because Bobby's teachers have noted difficulties in his ability to learn to read. Specifically, Bobby's teachers say that he has difficulties with word recognition and reading comprehension. Bobby's mother indicates that this is consistent with her own observations that he seems to have trouble with understanding what is being said (eg, directions, questions) and storytelling. Moreover, she suspects that Bobby's vocabulary is less well developed compared with his peers. She also describes frequent errors in how he formulates sentences such as omitting possessives (eg, “Sam dog” instead of “Sam's dog”) and verbs (eg, “He cooking” instead of “He is cooking”) that she fears are atypical. Bobby's nonverbal IQ is in the typical range.

The difficulties described above are most consistent with a possible diagnosis of:

• ○ Autism spectrum disorder
• ○ Intellectual disability
• ○ Specific language impairment
• ○ Language delay

Answer: Specific language impairment.

Darius [pseudonym] is a 5-year-old African American boy whom you are meeting today for the first time. He and his mother have recently moved to your area and she has brought him to you because he seems to be developing a nasty cough. When talking with Darius, you notice that he is extremely difficult to understand. Darius is a speaker of African American English; however, even with young speakers of this dialect, you have never had such difficulty understanding and communicating effectively. You learn that he and his parents have just moved from an impoverished community in South Carolina where he attended an age-appropriate class in a school in which approximately 85% of his classmates were black, to a school district in your area that almost entirely comprises white administrators, staff, and students. His mother further reports that Darius's new teachers have expressed concerns about his language. They say he is hard to understand, has a limited vocabulary, cannot master letter-sound correspondences, and has trouble listening to and understanding others.

Which of the following additional patient characteristics obtained from the mother would increase your suspicion of a diagnosis of speech and language impairment? (Select all that apply.)

• ▪ Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers
• ▪ Darius's scores on a test of articulation of standard English are in the 10th percentile
• ▪ Darius becomes frustrated when you ask him to repeat himself
• ▪ Even though they are consistent with the sound structure of African American English, errors in Darius's spelling are quite common (eg, he writes "nes" instead of “nest”)

Answer: Darius's mother reports that he has always talked differently compared with his parents, siblings, and peers.

Which of the following additional patient or parent characteristics would increase your suspicion that Darius is exhibiting a language difference as opposed to a speech and language impairment? (Select all that apply.)

• ▪ Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community
• ▪ Darius's scores on a test of vocabulary standardized on a cross-section of North American native English speakers are in the 35th percentile
• ▪ Darius's mother has no trouble understanding him
• ▪ Darius's mother does not share these concerns and considers him competent in all aspects of his language development

Answer: Not only do you find Darius difficult to understand, but his mother is equally difficult to understand; both seem to be using a variation of African American English dialect that, although not commonly heard in your area, is characteristic of their native community. Darius's mother does not share these concerns and considers him competent in all aspects of his language development.

You have been Sam's [pseudonym] primary care physician since he was born. He is now 18 months old and comes to you for his annual flu shot. During this visit, his mother expresses concerns about his speech and language development. More specifically, she reports he is “not talking like other kids his age” and uses repeated vocalizations (eg, “eh eh eh eh” while pointing) to communicate. Very recently, Sam has begun to use some words which are often paired with a gesture (eg, “Daddy” while pointing or “up” while raising hands to be picked up). You notice during your visit that Sam is a social and attentive child. He looks at other people and follows their eye gaze to distal objects. He also seems to understand the speech that his mother directs to him and he can easily carry out 2-step commands (eg, “Pick up the cup and sit next to me, please”). Sam's mother is aware of no immediate or extended family members who have ever had a speech or language impairment. Sam has no history of ear infection, and a recent hearing screen indicated hearing in the normal range.

• ▪ Limited imitation
• ▪ Limited pretend play
• ▪ Limited facial expressiveness
• ▪ Excessive use of nonverbal communicative gestures (eg, reaching, pointing, looking)

Answer: Limited imitation. Limited pretend play.

What should the mother expect with time if her child does not have a speech and language impairment but is rather a late-talker? (Select all that apply.)

• ▪ The child will begin to engage in unusual repetitive behaviors
• ▪ The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances
• ▪ Any new words that the child utters are likely to be distorted and difficult to understand
• ▪ The child may develop aggressive behaviors to cope with his inability to communicate effectively

Answer: The child will steadily albeit slowly add new words and begin to combine them into 2-word utterances.

Theresa [pseudonym] is a 3-year-old female whom you have seen in your office regularly since her birth. She comes to you today for her annual check-up. During her visit, you observe that Theresa is precocious in her language development. Indeed, her mother reports that she has always been a “great talker” and that she began to speak in well-formed utterances at age 18 months. During this visit, you notice a number of disfluencies in Theresa's speech. At one point, she repeats a word 3 times before getting the rest of the sentence out (ie, “I see… see… see a book with a clown”). Theresa's mother states that these kinds of disfluencies began about 1 month ago and, although she characterizes them as relatively infrequent, she has questions about whether this kind of speech is normal.

Which of the following additional patient characteristics obtained from your observation of Theresa would increase your suspicion of a diagnosis of a fluency disorder? (Select all that apply.)

• ▪ Theresa seems aware of and perturbed by her disfluencies
• ▪ Theresa sometimes jerks her head when hesitating to utter her next word
• ▪ Approximately 20% of Theresa's words appear to constitute disfluencies
• ▪ Theresa produces multi-unit syllable repetitions (eg, “t-t-t-time”)
• ▪ All of the above

Answer: All of the above.

Reader Comments on: Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood See reader comments on this article and provide your own.

Readers are encouraged to respond to the author at [email protected] or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine , for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: ten.epacsdem@grebdnulg

Contributor Information

Patricia A. Prelock, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Tiffany Hutchins, Department of Communication Sciences, University of Vermont, Burlington, Vermont.

Frances P. Glascoe, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee.

• Children's Health

What Is a Lisp?

A lisp is a speech impediment that specifically relates to making the sounds associated with the letters S and Z. Lisps usually develop during childhood and often go away on their own. But some persist and require treatment.

What Causes a Lisp?

There are no known causes of lisps. Some people think that using a pacifier after a certain age may contribute to lisps. They believe prolonged pacifier use can strengthen the muscles of the tongue and lips, making lisps more likely. However, pacifier usage is not a factor in every child with a lisp. Additionally, each child who uses a pacifier doesn't get a lisp.

Other possible causes of lisps include:

• Tongue-tie — a condition where the tongue is tethered to the bottom of the mouth. This restricts its movement. Another name for a tongue-tie is ankyloglossia.
• Problems with jaw alignment.
• Simply having learned to say the sound incorrectly.

When Is Lisping a Concern?

Many young children have some kind of lisp as they learn to talk. It is one of the most common speech impediments. About 23% of speech-language pathologist clients have lisps. 

However, you may want to look into professional help if your child is still lisping after the age of 4 1/2. However, children as young as three years old can work on lisping with a speech-language pathologist.

Types of Lisps

There are four types of lisps:

• Frontal lisp. This lisp occurs when you push your tongue too far forward, making a "th" sound when trying to words with S or Z in them.
• Lateral lisp. Extra air slides over your tongue when making S and Z sounds, making it sound like there is excess saliva.
• Palatal lisp. You touch your tongue to the roof of your mouth when making S and Z sounds.
• Dental lisp. This lisp sounds like a frontal lisp. The difference is that instead of pushing the tongue through the teeth, it is pressing against the teeth.

Treatment for Lisps

Speech-language pathologists are specialists who can help children with lisps. They will evaluate what type of lisp your child has and then help them with it over a period of time. It can take anywhere from a few months to a few years to get rid of a lisp. If a child is older when they start working with a speech-language pathologist, it may take a longer time. 

Speech pathologists work with people who have lisps to help them recognize what their lisp sounds like and how to position their tongue in the correct place to make the sound. They do this by giving them exercises to do, like saying specific words or phrases with the sounds in them. Once your child has been working on their lisp for a while, your speech pathologist will engage them in conversation to challenge them to remember proper tongue placement.

If your child's lisp is from a tongue-tie, a doctor may recommend a simple in-office procedure called a frenotomy to reduce the tethering. They take a pair of scissors and snip the excess tissue holding the tongue down. If the tongue-tie is more severe, a surgery called a frenuloplasty may be required.

How to Find a Speech-Language Pathologist

Make sure that any speech-language pathologist you take your child to is licensed. In the US, each state has a different licensure process for speech-language therapists. They may also opt to get an additional certification from ASHA — the American Speech-Language-Hearing Association. Those who have this certification show they meet certain qualifications and follow ASHA's code of ethics. 

You should also make sure the speech-language therapist is child-friendly. You may be able to find this information on their website or by reading reviews online. In the session, you can also observe the interaction to make sure you are comfortable with how the therapist is treating your child.

After evaluation, the speech-language pathologist should be able to tell which type of lisp your child has. They should also be able to recommend exercises specific to that type of lisp to help your child. 

Other Types of Speech Impediments

Lisps are just one type of speech impediment. Other common speech impediments include:

• Lambdacism. Trouble saying the letter L. People with lambdacism often use the R sound as a substitute.
• Rhotacism. Difficulty with saying the letter R correctly.

The three most common speech impediments are sigmatism (lisping), lambdacism, and rhotacism. However, other people can also have trouble pronouncing the sounds associated with the letters K, G, T, D, and E. 

Home Remedies to Help Lisps

Whether or not your child sees a speech-language pathologist, there are things you can do at home to help your child's lisp, including:

• Treat allergies and sinus problems that may lead to lisping.
• Curb thumb sucking .
• Have your child drink through a straw to build strength.
• Encourage playtime with things like bubbles or horns.

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