what causes a speech impediment

• Bachelor’s Degrees
• Master’s Degrees
• Doctorate Degrees
• Certificate Programs
• Nursing Degrees
• Cybersecurity
• Human Services
• Science & Mathematics
• Communication
• Liberal Arts
• Social Sciences
• Computer Science
• Admissions Overview
• Tuition and Financial Aid
• Incoming Freshman and Graduate Students
• Transfer Students
• Military Students
• International Students
• Early Access Program
• About Maryville
• Our Faculty
• Our Approach
• Our History
• Accreditation
• Tales of the Brave
• Student Support Overview
• Online Learning Tools
• Infographics

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.

Back To Top

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”

Bring us your ambition and we’ll guide you along a personalized path to a quality education that’s designed to change your life.

Take Your Next Brave Step

Receive information about the benefits of our programs, the courses you'll take, and what you need to apply.

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

What Is a Speech Sound Disorder?

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

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Halfpoint Images / Getty Images

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.

• Patient Care & Health Information
• Diseases & Conditions
• Childhood apraxia of speech

Childhood apraxia of speech (CAS) is a rare speech disorder. Children with this disorder have trouble controlling their lips, jaws and tongues when speaking.

In CAS , the brain has trouble planning for speech movement. The brain isn't able to properly direct the movements needed for speech. The speech muscles aren't weak, but the muscles don't form words the right way.

To speak correctly, the brain has to make plans that tell the speech muscles how to move the lips, jaw and tongue. The movements usually result in accurate sounds and words spoken at the proper speed and rhythm. CAS affects this process.

CAS is often treated with speech therapy. During speech therapy, a speech-language pathologist teaches the child to practice the correct way to say words, syllables and phrases.

Children with childhood apraxia of speech (CAS) may have a variety of speech symptoms. Symptoms vary depending on a child's age and the severity of the speech problems.

CAS can result in:

• Babbling less or making fewer vocal sounds than is typical between the ages of 7 to 12 months.
• Speaking first words late, typically after ages 12 to 18 months old.
• Using a limited number of consonants and vowels.
• Often leaving out sounds when speaking.
• Using speech that is hard to understand.

These symptoms are usually noticed between ages 18 months and 2 years. Symptoms at this age may indicate suspected CAS . Suspected CAS means a child may potentially have this speech disorder. The child's speech development should be watched to determine if therapy should begin.

Children usually produce more speech between ages 2 and 4. Signs that may indicate CAS include:

• Vowel and consonant distortions.
• Pauses between syllables or words.
• Voicing errors, such as "pie" sounding like "bye."

Many children with CAS have trouble getting their jaws, lips and tongues to the correct positions to make a sound. They also may have a hard time moving smoothly to the next sound.

Many children with CAS also have language problems, such as reduced vocabulary or trouble with word order.

Some symptoms may be unique to children with CAS , which helps to make a diagnosis. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's hard to diagnose CAS if a child has only symptoms that are found both in CAS and in other disorders.

Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those associated with CAS include:

• Trouble moving smoothly from one sound, syllable or word to another.
• Groping movements with the jaw, lips or tongue to try to make the correct movement for speech sounds.
• Vowel distortions, such as trying to use the correct vowel but saying it incorrectly.
• Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh."
• Using equal emphasis on all syllables, such as saying "BUH-NAN-UH."
• Separation of syllables, such as putting a pause or gap between syllables.
• Inconsistency, such as making different errors when trying to say the same word a second time.
• Having a hard time imitating simple words.
• Voicing errors, such as saying "down" instead of "town."

Other speech disorders sometimes confused with CAS

Some speech sound disorders often get confused with CAS because some of the symptoms may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.

A child with an articulation or phonological disorder has trouble learning how to make and use specific sounds. Unlike in CAS , the child doesn't have trouble planning or coordinating the movements to speak. Articulation and phonological disorders are more common than CAS .

Articulation or phonological speech errors may include:

• Substituting sounds. The child might say "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup."
• Leaving out final consonants. A child with CAS might say "duh" instead of "duck" or "uh" instead of "up."
• Stopping the airstream. The child might say "tun" instead of "sun" or "doo" instead of "zoo."
• Simplifying sound combinations. The child might say "ting" instead of "string" or "fog" instead of "frog."

Dysarthria is a speech disorder that occurs because the speech muscles are weak. Making speech sounds is hard because the speech muscles can't move as far, as quickly or as strongly as they do during typical speech. People with dysarthria may also have a hoarse, soft or even strained voice. Or they may have slurred or slow speech.

Dysarthria is often easier to identify than CAS . However, when dysarthria is caused by damage to areas of the brain that affect coordination, it can be hard to determine the differences between CAS and dysarthria.

Childhood apraxia of speech (CAS) has a number of possible causes. But often a cause can't be determined. There usually isn't an observable problem in the brain of a child with CAS .

However, CAS can be the result of brain conditions or injury. These may include a stroke, infections or traumatic brain injury.

CAS also may occur as a symptom of a genetic disorder, syndrome or metabolic condition.

CAS is sometimes referred to as developmental apraxia. But children with CAS don't make typical developmental sound errors and they don't grow out of CAS . This is unlike children with delayed speech or developmental disorders who typically follow patterns in speech and sounds development but at a slower pace than usual.

Risk factors

Changes in the FOXP2 gene appear to increase the risk of childhood apraxia of speech (CAS) and other speech and language disorders. The FOXP2 gene may be involved in how certain nerves and pathways in the brain develop. Researchers continue to study how changes in the FOXP2 gene may affect motor coordination and speech and language processing in the brain. Other genes also may impact motor speech development.

Complications

Many children with childhood apraxia of speech (CAS) have other problems that affect their ability to communicate. These problems aren't due to CAS , but they may be seen along with CAS .

Symptoms or problems that are often present along with CAS include:

• Delayed language. This may include trouble understanding speech, reduced vocabulary, or not using correct grammar when putting words together in a phrase or sentence.
• Delays in intellectual and motor development and problems with reading, spelling and writing.
• Trouble with gross and fine motor movement skills or coordination.
• Trouble using communication in social interactions.

Diagnosing and treating childhood apraxia of speech at an early stage may reduce the risk of long-term persistence of the problem. If your child experiences speech problems, have a speech-language pathologist evaluate your child as soon as you notice any speech problems.

Childhood apraxia of speech care at Mayo Clinic

• 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 April 6, 2023.
• Carter J, et al. Etiology of speech and language disorders in children. https://www.uptodate.com/contents/search. Accessed April 6, 2023.
• Childhood apraxia of speech. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/. Accessed April 6, 2023.
• Apraxia of speech. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx. Accessed April 6, 2023.
• Ng WL, et al. Predicting treatment of outcomes in rapid syllable transition treatment: An individual participant data meta-analysis. Journal of Speech, Language and Hearing Research. 2022; doi:10.1044/2022_JSLHR-21-00617.
• Speech sound disorders. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/. Accessed April 6, 2023.
• Iuzzini-Seigel J. Prologue to the forum: Care of the whole child — Key considerations when working with children with childhood apraxia of speech. Language, Speech and Hearing Services in Schools. 2022; doi:10.1044/2022_LSHSS-22-00119.
• Namasivayam AK, et al. Speech sound disorders in children: An articulatory phonology perspective. 2020; doi:10.3389/fpsyg.2019.02998.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
• Ami TR. Allscripts EPSi. Mayo Clinic. March 13, 2023.
• Kliegman RM, et al. Language development and communication disorders. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 6, 2023.
• Adam MP, et al., eds. FOXP2-related speech and language disorder. In: GeneReviews. University of Washington, Seattle; 1993-2023. https://www.ncbi.nlm.nih.gov/books/NBK1116. Accessed April 6, 2023.
• How is CAS diagnosed? Childhood Apraxia of Speech Association of North America. https://www.apraxia-kids.org/apraxia_kids_library/how-is-cas-diagnosed/. Accessed April 13, 2023.
• Chenausky KV, et al. The importance of deep speech phenotyping for neurodevelopmental and genetic disorders: A conceptual review. Journal of Neurodevelopmental Disorders. 2022; doi:10.1186/s11689-022-09443-z.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments
• Care at Mayo Clinic

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Make twice the impact

Your gift can go twice as far to advance cancer research and care!

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Supplements
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

What Is Apraxia of Speech?

A Challenging Language Disorder

Apraxia of speech is a language impairment that occurs due to brain damage. The underlying causes of apraxia of speech are usually different for children than for adults. Speech apraxia is difficult to cope with, and speech therapy can help improve communication.

Diagnosis of the underlying cause is crucial, both to help direct treatment for speech difficulties and to treat and prevent further neurological problems.

Illustration by Zoe Hansen for Verywell Health

Apraxia of Speech Symptoms 

Speech apraxia leads to significant difficulties in communicating. This condition usually causes persistent symptoms and typically doesn't change.

People with apraxia of speech are cognitively and physically able to produce words and sentences. Language comprehension should not be affected by apraxia of speech, and words are not slurred in apraxia of speech.

Features of apraxia of speech include the following:

• Distortion of sounds : The sounds of words and phrases are often wrong in speech apraxia. For example, the vowels or consonants might be drawn out for too long.
• Inconsistency in pronouncing words and sounds : The mispronunciation of words with speech apraxia is not necessarily consistent. For example, you could have difficulty with the first part of a word, and the next time you say that word, you might have difficulty with the middle or the end.
• Struggling for words : If you have apraxia of speech, you will work hard to say the words you want to say.
• Errors in speech : You might use the wrong words and phrases if you have apraxia of speech, despite knowing what you mean to say.

Other cognitive or physical problems can often occur with speech apraxia, depending on the underlying cause.

Apraxia vs. Other Speech and Language Disorders

Apraxia of speech is a type of language disorder. Aphasia is the most common language impairment, and dysarthria is a speech impairment caused by difficulty with motor speech function. Apraxia is distinct from these disorders, although they may share some similarities. Common speech disorders include:

• Receptive aphasia : Usually referred to as Wernicke’s aphasia, this type of language impairment is characterized by fluid speech that usually doesn’t make sense, often with word substitutions. Language comprehension is typically impaired with Wernicke’s aphasia.
• Impaired fluency : Often described as Broca’s aphasia , this is a language problem that causes people to have choppy speech without a normal rhythm. Usually, speech comprehension is not substantially affected by Broca’s aphasia.
• Conduction aphasia : In conduction aphasia, the problem is the ability to repeat a short sentence. Expression and comprehension of speech are spared.
• Dysarthria : This condition is characterized by slurred speech or difficulty making certain sounds. Usually, people with dysarthria without aphasia can understand language and may know which words they want to say but have difficulty pronouncing them.

Speech apraxia is caused by damage to regions in the brain that mediate communication between language regions in the brain and between the left and right hemispheres of the brain.

This can occur with developmental conditions, such as autism, or it may result from harm to the brain, such as from head trauma.

Conditions associated with apraxia of speech include:

• Autism spectrum disorder
• Cerebral palsy
• Head trauma
• Brain tumors
• Brain surgery

These conditions are not always associated with apraxia of speech. But they can sometimes cause damage or dysfunction to regions of the brain that allow communication between the right and left hemispheres—and then they could be associated with speech apraxia.

Speech apraxia is diagnosed based on a clinical evaluation, usually by a physician or a speech therapist . A detailed examination of speech and cognitive abilities is necessary to define apraxia of speech and to rule out other disorders that can cause similar speech and language patterns, such as dysarthria and aphasia.

Speech patterns noted in apraxia of speech include the following:

• Phonemic error frequency : This involves assessment of the frequency of mistakes while pronouncing words.
• Distortion error frequency : This is a count of how often sounds are altered during speech.
• Word syllable duration : This involves assessment of the extra time in saying a word, usually due to struggling.

The Apraxia of Speech Rating Scale (ASRS) is one of the ways that speech apraxia can be defined. Healthcare providers can use this scale to communicate with each other and follow the improvement of apraxia of speech with therapy. The ASRS includes 16 components, such as repetition of sounds or inaccurate sounds, that are rated on a scale from zero to four.

If you’ve been diagnosed with speech apraxia or any communication problem, healthcare providers will work to determine the underlying cause. Issues such as childhood neurodevelopmental problems, stroke, brain tumors, or damage from a head injury need to be identified and treated.

Diagnostic testing may include:

• Brain imaging tests : These tests can help identify common causes of apraxia of speech, such as a stroke or head trauma.
• Cognitive testing : These tests may be used as part of the assessment for autism, dementia, or psychiatric conditions, which may be related to speech challenges.
• Blood tests : Medical problems such as infections, electrolyte disturbances , or organ failure may cause communication difficulties.

In addition to diagnosing speech apraxia, your healthcare providers will also work to determine whether you have other neurological deficits that could be caused by the underlying issue causing your speech apraxia. These can include learning difficulties, behavioral problems, or body weakness.

Apraxia of speech is treated with speech therapy . This type of therapy will follow patterns of treatment that are well-established for improving speech and will also provide an individualized treatment plan.

Therapy may need to be ongoing, and the frequency and specific exercises used during your therapy can be adjusted as you improve. For example, if your speech improves substantially, you might be able to work with your speech therapist less frequently, or you may be able to do some speech exercises at home, as directed by your therapist.

It’s not possible to predict with absolute certainty whether a person will recover from apraxia of speech and how much they might improve. However, there are some diagnostic clues that can help in anticipating the extent of recovery. 

If you or a loved one has apraxia of speech, it can help to know that the ability to participate in speech therapy can lead to better outcomes. If your cognitive function is not affected or is only mildly impaired, this can help you take an active role in your therapy.

Research About Prognosis and Treatment

Stronger connectivity between certain areas of the right and left hemispheres of the brain is associated with better recovery.

For example, one research study showed that early connectivity of the inferior frontal gyrus (an area that processes speech and language) within two weeks after a stroke may be a strong predictor of recovery of apraxia of speech.  

And at six months, lower severity of speech apraxia was associated with stronger connectivity of the anterior insula (which supports subjective feelings) on the right and left hemispheres and the ventral premotor cortex (which is involved in grasping and manipulating objects) of the right and left hemispheres.

This type of connectivity can be identified with metabolic brain testing, which is time-consuming and often impractical. However, this research can help scientists learn about ways to improve treatment for people with apraxia of speech.

Living with a language impairment can be difficult. Communication challenges interfere with relationships and day-to-day life. This can require extra effort from family, friends, and everybody else who interacts with a person who has apraxia of speech.

Patience is essential to managing this communication difficulty. It is important to work with your speech therapist in order to identify ways to communicate as you work to recover. This can include using pictures, gestures, and other ways of expressing your needs.

Apraxia of speech is a type of language impairment that is caused by damage to the brain, either during fetal development, childhood, or adulthood. This condition can occur along with other neurological deficits that are associated with damage to the brain.

There are many different causes, and a diagnosis of the cause is essential for a comprehensive treatment of speech apraxia, as well as any associated physical and cognitive deficits. Speech therapy is the treatment for the speech impairment seen in this condition.

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Vogindroukas I, Stankova M, Chelas EN, Proedrou A. Language and speech characteristics in autism . Neuropsychiatr Dis Treat . 2022;18:2367-2377. doi:10.2147/NDT.S331987

Haley KL, Jacks A. Three-dimensional speech profiles in stroke aphasia and apraxia of speech . Am J Speech Lang Pathol. 2023:1-10. doi:10.1044/2022_AJSLP-22-00170

Hybbinette H, Östberg P, Schalling E, et al. Longitudinal changes in functional connectivity in speech motor networks in apraxia of speech after stroke . Front Neurol. 2022;13:1013652. doi:10.3389/fneur.2022.1013652

Duffy JR, Martin PR, Clark HM, et al. The apraxia of speech rating scale: reliability, validity, and utility . Am J Speech Lang Pathol. 2023;32(2):469-491. doi:10.1044/2022_AJSLP-22-00148

Zhao J, Li Y, Zhang X, et al. Alteration of network connectivity in stroke patients with apraxia of speech after tDCS: a randomized controlled study . Front Neurol. 2022;13:969786. doi:10.3389/fneur.2022.969786

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.

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. That said, those listed below are common symptoms that could be initial indicators that you or your child may be experiencing speech problems or challenges:

• 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.

Key categories of speech impediments

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.

Examples of speech impediments

Below is a brief overview of a few of the most common speech disorders and speech impediments, along with symptoms and potential treatment options.

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.

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.

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).

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.

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. 

The importance of treatment

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

Seeking professional support

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. 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. 

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. 

• Recognizing And Navigating Teen Depression Medically reviewed by Elizabeth Erban , LMFT, IMH-E
• ADHD Signs In Women, Men, And Children Medically reviewed by Julie Dodson , MA
• Relationships and Relations

Enjoy free shipping today! Enter code SHIP1MD at checkout.

Get free shipping today! Use code SHIP1MD

Shop By Health Suite

Designed by top doctors and the scientifically proven to make a difference.

• Digestive Health
• Heart Health
• Bone Health
• Joint Health
• Men's Health
• Immune Health
• Brain Health
• Health Guides

Comprehensive health guides of symptoms and disorders, helpful ingredients and recipes.

• Digestive Guide
• Heart Guide
• Joint Guide
• Men's Guide
• Immune Guide
• Brain Guide
• Our Doctors

Board-certified doctors, who spend time working in the field and shaping the future of medicine

About 1MD Nutrition™

Physician-formulated supplements that deliver real, powerful results.

• The 1MD Nutrition™ Promise
• Subscribe and Save

Your cart is empty.

• heart Guide

Speech Impairment: Symptoms, Causes, and When to See Your Doctor

Speech impairment in adults is a symptom that causes difficulty in speaking or pronouncing words. This can be a temporary condition, or it can be a symptom of a severe medical condition. This guide will show you what to look for and when to see a doctor.

9 minute read

Last Updated September 20, 2021

Speech impairment in adults is any symptom that causes difficulty in speaking or pronouncing words. Speech impairments can include slurred, rapid, stuttered, hoarse, or slowed speech, and they can be caused by any number of factors. 

Some cases of impaired speech may be temporary, while others are caused by an underlying medical condition. When speech impairment is sudden, then it is a symptom of a serious problem , such as a heart attack or stroke, and requires immediate medical attention.

Symptoms of Speech impairment

Along with an inability to clearly communicate verbally, you can also experience other symptoms with speech impairment. 

♦ Weakened facial muscles ♦ Difficulty remembering words ♦ Deficits with expressive language ♦ Drooling ♦ Sudden contraction of vocal muscles

Causes of Speech Impairment

The different types of speech impairment have different causes, and you can develop speech impairment suddenly or gradually. 

♦ Aphasia: This is when you have difficulty thinking of words or pronouncing them, and the potential causes of this type include head trauma, brain tumors, and degenerative diseases such as Alzheimer’s disease. 

♦ Dysarthria: This is when you have trouble moving your lips, tongue, vocal folds, or diaphragm. This typically results from degenerative muscle conditions such as multiple sclerosis as well as stroke, head trauma, Bell’s palsy, Lyme disease, and excessive alcohol consumption.

♦ Vocal disorders: This affects your ability to speak and is caused by injuries to the area, throat cancer, polyps or nodules on the vocal cords, and consumption of drugs like antidepressants. 

♦ Spasmodic dysphonia: This involves involuntary movements of the vocal cords. The exact cause is unknown, but this impairment is linked to abnormal brain functioning. 

Diseases Associated with Speech Impairment

There can be temporary causes of speech impairment, but in most cases, there is an underlying condition impacting the speech region of the brain. Sudden speech impairment can be a sign of a serious medical condition that requires immediate medical attention.

♦  Stroke : Speech impairment and disorders are common after a stroke, but they can also be signs of an impending stroke. Slurred speech, along with facial muscle changes, can indicate a stroke and should not be ignored.

♦ Cardiovascular disease : Heart disease can cause structural changes in the brain as a result of reduced blood flow. Cognitive abilities and communication can be impacted as a result.

♦ Multiple sclerosis : This condition causes lesions that damaged parts of the brain, which can impair speech patterns.

♦ Infections : Viral and bacterial infections that reach the brain can cause damage to the areas that process language, causing temporary speech impairment. 

♦ Huntington’s Disease : This disease mostly affects movement, but the majority of patients with Huntington’s also report speech difficulties.

♦ Alzheimer’s disease : Speech impairment can develop as a result of plaques in the brain that are associated with Alzheimer’s disease. 

♦ Parkinson’s : Difficulty speaking and swallowing is common with Parkinson’s disease and gets worse as the disease progresses. 

♦ Cholesterol : High cholesterol can lead to the formation of plaques in the arteries, and without treatment, these increase your risk for stroke, which can cause speech impairment.

♦ Cancer : A tumor in your brain located near the speech center will cause speech impairments as well as changes in memory, seizures, and severe headaches.

♦ Head trauma : Injury, internal bleeding, or bruising to the brain, as a result of head trauma can impact speech. Depending on the severity and location of the trauma, speech impairment may be temporary or permanent.

Diagnosis of Speech Impairment

When speech impairment appears suddenly, seek immediate medical attention . When it develops more gradually, you need to see your doctor for testing, in case there is an underlying condition as the cause. 

You may experience speech impairment after using your voice too much or after an infection, but prolonged impairment requires attention and testing for diagnosis. Your doctor will start with a physical examination and discuss your medical history and symptoms. They will also talk with you to evaluate your speech during a discussion and to determine your level of comprehension and speaking ability. 

In addition to this, testing can be done to attempt to identify possible underlying causes. The most common tests include:

♦ Blood tests ♦ Electrical current tests ♦ MRI, CT, and x-Ray scans ♦ Urine tests

It may also be necessary for you to follow up with specialists such as a neurologist, speech pathologist, or otolaryngologist for more detailed testing and analysis.

Treatment for Speech impairment

The treatment will depend on the cause and severity of your speech impairment. In all cases of speech impairment, the underlying cause needs to be treated in order to restore speech. 

Exercises can be done to help strengthen vocal cords and improve articulation. You can also use assistive communication devices. Only in certain situations will surgery or any other invasive procedure be required. If the cause of your speech impairment is a stroke or heart disease, medications are prescribed as well as surgery. Your doctor will also recommend a heart-healthy lifestyle to follow.

In addition to any medical treatment plan given to you by your doctor, there are things you can try to help protect your voice, and prevent or limit the severity of a speech impairment. 

♦ Always wear protective headgear to prevent brain injuries. ♦ Quit or avoid smoking and second-hand smoke to reduce the risk of throat cancer. ♦ Limit consumption of alcohol. ♦ Get regular exercise to reduce the risk of stroke. ♦ Follow a balanced diet to protect against hypertension and high cholesterol.

Natural Treatment for Speech Impairment

Most of the causes of speech impairment will require medical treatment. However, there are certain conditions related to heart health that you can prevent naturally. Stroke and atherosclerosis are both related to high cholesterol and clogged arteries. 

By incorporating specific natural ingredients into your diet, you can promote overall heart health by reducing cholesterol levels. This will reduce your risk of heart-related conditions that can cause speech impairment. The top ingredients to try include:

♦ Berberine bark extract both lowers cholesterol and fights inflammation to protect against heart disease.  ♦ Chromium benefits the heart by reducing the risk of high cholesterol and arterial clogs . This significantly reduces the risk of stroke. ♦ Lion’s mane mushroom improves the good-to-bad ratio of cholesterol in your blood to protect against stroke. ♦ Niacin works to lower cholesterol and blood lipid levels to reduce the risk of heart attack and stroke. Studies have found that it works more effectively than cholesterol-lowering statins.  ♦ Pine bark extract helps lower bad cholesterol, which prevents clogged arteries and reduces the risk of stroke. This extract also reduces inflammation that can cause platelets to clump together, forming dangerous clots known to increase stroke risk.

When to See Your Doctor

The gradual development of speech impairment can be caused by a number of conditions or factors that can be effectively treated once identified. 

If you notice the sudden onset of any speech impairment, you need to seek immediate medical attention, as this is a common sign of a stroke. Without treatment, a stroke can cause permanent damage to your heart and brain and even death. 

While speech impairment may develop from a relatively harmless condition, the risk of stroke cannot be ignored, so be sure to seek help if impairment appears suddenly.

Sign up for 1MD Nutrition™ Email Exclusives!

Be first in line for major savings, fitness and nutrition tips, health news, and more

Thank You For Joining the 1MD Nutrition™ Health Club!

Related Heart Symptoms Articles

Is Your Erectile Dysfunction Being Caused by High Blood Pressure?

Erectile dysfunction can be caused by high blood pressure. Understanding this connection is the firs...

Abdominal Pain: Causes, Types, and When to See a Doctor

Abdominal pain is considered to be any pain that occurs in the area between your chest and pelvis. T...

High Cholesterol: Symptoms, Causes, and Diet as Treatment

Cholesterol plays a vital role in the body's ability to function. High cholesterol, when caused by u...

Insulin Resistance: Causes, Symptoms, and Long-Term Outlook

Insulin is key to the metabolic process of regulating nutrients in the body. Insulin resistance is w...

Leg Pain: Causes, Associated Conditions, and Treatment

Leg pain can occur for a number of reasons, and it can range from mild to severe. Everything from di...

Discolored Urine: Causes, Associated Conditions, and Diagnosis

Most causes of discolored urine are harmless, but others are more serious. These are some of the sig...

High Blood Sugar: Causes, Complications, and How to Lower Blood Sugar

Your body breaks down glucose for energy using the insulin produced by the pancreas. This is require...

Low Blood Pressure: Causes, Symptoms, and Natural Treatment

With each heartbeat, your blood is pushed against your arteries. Low blood pressure happens when you...

Weight Gain: Symptoms, Causes, and When To See Your Doctor

Metabolic weight gain can occur naturally, oftentimes because of hormonal changes, but there are als...

Nausea: Causes, Associated Conditions, and When to See Your Doctor

Nausea is the uncomfortable feeling you get in your stomach that sometimes leads to vomiting. It has...

What Is Frequent Urination?

A urinary tract infection is the most common cause, of frequent urination. Frequent urination is def...

Causes of Unintentional Weight Loss

Losing weight is something many people struggle to accomplish, but weight loss can become a problem ...

What Causes Indigestion?

What exactly is Indigestion? 1MD provides you with information on causes, symptoms, and when to see ...

What Is Sweat?

What are the main causes of sweating? 1MD explains the treatments and when the right time to see a ...

Coma: Causes, Symptoms, and Long-Term Outlook

What is a coma? 1MD explains their causes, how they affect the body, symptoms, and long-term outlook...

Dizziness: Causes, Natural Remedies, and When to See Your Doctor

What exactly causes dizziness? 1MD can help you understand the causes of dizziness and its associate...

Shortness of Breath: Symptoms, Causes, and When to See Your Doctor

Learn about the causes of shortness of breath in this informative article. Shortness of breath may b...

Blurred Vision: Causes, Prevention, and When to See Your Doctor

Blurry vision may be a sign of an underlying condition. 1MD provides you with the best information o...

What Is an Irregular Heartbeat?

Irregular heartbeats are common and often temporary, but sometimes they can signal an underlying hea...

Chest Pain: Symptoms, Causes, and When to See Your Doctor

Are you experiencing chest pain? Find out the possible chest pain causes and treatment.

Fatigue/Low Energy: Symptoms, Causes, and Treatment

Chronic fatigue and continued low energy levels can take a toll on your life and can be a symptom of...

Loss of Appetite: Causes, Natural Remedies, and the Long-Term Outlook

When loss of appetite is not treated, long-term complications can arise such as extreme fatigue, exc...

High Stress: Symptoms, Causes, Complications, and Treatment

Everybody experiences stress from time to time, and it can be the result of good or bad stressors. B...

Malnutrition: Signs, Associated Diseases, and Treatments

Malnutrition is a condition where your body is not getting enough nutrients. The effects can include...

Insomnia: Symptoms, Treatment, and When to See Your Doctor

Sleep is essential for optimal health. If you’re not able to fall asleep or you have trouble stayi...

Low Metabolism: Symptoms, Causes, and Long-Term Outlook

Metabolism is the process in your body responsible for maintaining life. This can change as a respon...

HEALTH GUIDES

• All Health Guides
• Health Stories
• BiomeMD® for Women
• CurcuminMD® Plus
• ProstateMD®
• CardioFitMD™

1MD NUTRITION™ INFORMATION

• Charity Partner
• Company FAQs
• Product FAQs
• Store Policies
• CA/VA Residents
• Partner With Us
• Privacy Policy
• Terms of Service
• Accessibility

The views/opinions expressed by contributors and/or product reviews are their own and not necessarily those of 1MD.org . These reviews should not be taken as recommendations but rather customer opinions of the products that they have used. The real 1MD Nutrition™ customers featured in our videos were compensated for their time. Results may vary. Furthermore, 1MD.org makes no warranty or representation, expressed or implied, as to the accuracy or sufficiency of the information contributed by outside sources, and assumes no responsibility or liability regarding the use of such information. All doctors mentioned and/or featured on this site are paid partners of 1MD Nutrition™. The statements on this site have not been evaluated by the FDA. The information provided in content sections, customer reviews and testimonials is intended for educational purposes only. Products sold on 1MD.org are not intended to diagnose, treat, cure, or prevent any disease. If you are pregnant, nursing, taking medication, have a medical condition, or are under the age of 18, consult your physician before using this product. Immediately discontinue use and consult your physician if you experience any adverse reaction to this product.

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

© 2024 1MD Nutrition™. All rights reserved

Subscription Box

Take an important step in achieving your health goals by signing up for 1MD Nutrition's Subscription Box today and receive your favorite products, while minimizing time and maximizing savings.

Low Price Promise

Sign up for Subscription and forget coupon clipping. Lock in a bargain basement price for the health supplements you want, guaranteed.

Hassle Free, Auto Ship

Select your preferred Subscription delivery frequency and relax, knowing you'll never run out of your favorite products.

Shipment Priority

Our Subscription customers are always in the front of the line, so when our stock is low, your favorite products are prioritized for shipment, automatically.

Postpone or Cancel Anytime

You're in the driver's seat with complete control and flexibility to cancel, postpone, or change your Subscription, anytime.

The Power Of Consistency

Signing up for 1MD Nutrition's Subscription Box means you can spend less time worrying and more time staying motivated and focused on your health routine.

We are your biggest health advocates, so let us help you stay on track by automatically sending your joint, heart, immunity, and digestive health support supplements all in one box, on time... and start enjoying a happier, healthier life today.

Put your health first with 1MD Nutrition™ Subscription Box

Skip Navigation

Oral Health

Whitening Products

Whitening Solutions

• All Optic White® products
• Pro Series Toothpaste
• ComfortFit LED Device
• Overnight Teeth Whitening Pen
• Express Teeth Whitening Pen
• Renewal Toothpaste
• Advanced Toothpaste
• Stain Fighter® Toothpaste
• Charcoal Toothpaste
• Whitening Mouthwash
• Adult Orthodontics (Braces)
• Bad Breath (Halitosis)
• Bridges & Crowns
• Brushing & Flossing
• Cleft Lip /Palate
• Cracked Tooth Syndrome
• Dental Emergencies & Sports Safety
• Dental Health Threats
• Dental Product Guidance
• Dental Sealants
• Dental Visits
• Developmental Conditions
• Diabetes & Endocrine Disorders
• Digestive (Gastrointestinal) Disorders
• Early Orthodontics (Braces)
• Gum Disease (Gingivitis)
• Heart Disease
• HIV/AIDS & STDS
• Immune Disorders
• Jaw Pain (TMD)
• Mouth & Teeth Anatomy
• Mouth Sores & Infections
• Nutrition & Oral Health
• Oral Cancers
• Oral Care: Babies (0-4)
• Oral Care: Kids (5-12)
• Oral Care: Teens (13-17)
• Oral Care: Adults (18+)
• Oral Care: Adults (55+)
• Pain Management (Anesthesia)
• Plaque & Tartar
• Pregnancy Oral Care
• Respiratory Conditions
• Root Canals
• Special Occasions
• Teeth Bonding
• Teeth Grinding (Bruxism)
• Teeth Whitening
• Tooth Extraction
• Tooth Fairy
• Tooth Sensitivity
• Wisdom Teeth
• View All Article Categories >
• Toothpastes
• Toothbrushes
• Mouthwashes & Rinses
• Prescription Products
• Specialty Products
• Teeth Whitening Products
• Colgate ® Total
• Colgate ® 360º
• Colgate ® MaxFresh ®
• Colgate ® with Charcoal
• Colgate ® Enamel Health ™
• Colgate ® Optic White ®
• Colgate ® Kids
• Colgate ® Sensitive
• Colgate ® Keep
• Colgate ® Renewal
• Colgate ® Hum
• View all products >
• Our Mission
• About our Mission
• Smile First
• Accessible Oral Care
• Innovation Champions
• Bright Smiles, Bright Futures
• About the Program
• Art Contest
• Classroom Kit & Samples
• Material and Resources
• Mobile Dental Vans
• Sustainability
• About Sustainability
• Recyclable Tube
• Sustainable Products
• Sustainable Habits
• Haz La U Grants

What Is a Lisp and What Causes It?

Top articles, more articles.

Medically Reviewed By Colgate Global Scientific Communications

If you or someone you know misarticulates certain phonetic sounds, it may be due to a lisp. The cause, effects and solutions for this speech disorder may differ, depending on the person. Here's why someone may have trouble making phonetic sounds correctly and what can be done about it.

What Are Lisps and What Causes Them?

A lisp is a common type of speech impediment. An article from Speech-Language Pathology Graduate Programs specifies several potential causes of lisping:

• Learning to pronounce sounds incorrectly
• Jaw alignment problems
• Tongue-tie , where the tongue is attached to the bottom of the mouth and movement is limited
• Tongue thrust , where the tongue protrudes out between the front teeth

Some of these issues are apparent from birth, such as a tongue-tie, while others, such as improper pronunciation, develop as a child learns to speak.

What Are the Types of Lisps?

There are four professional categories of lisps, as the Speech-Language Pathology Graduate Programs outlines. The first is a frontal lisp, which is the most common and occurs when individuals push their tongues too far forward. The second is a lateral lisp, which happens if air moves over the sides of the tongue when speaking, resulting in a slurred sound. People with palatal lisps, the third kind, touch their tongue to the roof of their mouth while saying certain sounds. Finally, the fourth kind, dental lisps, are easily confused with frontal lisps, but these occur when the individual pushes their tongue against the teeth — not through them.

The Connection Between Lisping and Misaligned Teeth

Malocclusion is the misalignment of teeth when biting down which occurs because the teeth are crooked or not spaced correctly.

In some cases, dental malocclusion can be directly linked to speech disorders. Research conducted in a 2021 study published in the Journal of Applied Oral Science determined that people with speech articulation issues, such as a lisp, have a high chance of malocclusion. However, malocclusion doesn't necessarily cause the speech disorder, and the severity of the disorder doesn't necessarily correlate to the severity of the malocclusion.

Some of the alignment issues associated with speech disorders include:

• Increased overjet
• Spacing between the teeth in the upper jaw

It is crucial for anyone who believes they have a speech disorder or a bite issue to get a professional diagnosis. It's especially important to determine if the lisp results from tongue thrust, as this condition can have significant dental consequences. Parents who notice speech difficulties in their children should seek evaluation.

How to Treat Speech Articulation Issues

Having a speech issue can be emotionally challenging. If you or someone you know has speech trouble, there are several ways to seek help. People with lisping issues can seek help from a dentist, orthodontist, doctor, or speech-language pathologist.

A dentist can check the positioning of the teeth and the size and shape of the palate and bite. A physician may look for other things, such as allergies and tonsil size, while a speech and language pathologist will likely focus on how the individual speaks, breathes, and eats. Sometimes, treating a speech issue requires a combination of professional interventions.

If you or someone you know suffers from a speech disorder, don't worry! There are many resources available for support and speech lisp therapy.

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider. 

Want more tips and offers sent directly to your inbox?

Sign up now

Recommended Products

Thank you for submitting your feedback!

If you’d like a response, Contact Us .

You also might like

Sign up now ">

Social Impact

Where to Buy

United States (US English)

ColgateProfessional.com

Shop.Colgate.com

Submit an Idea

© YYYY Colgate-Palmolive Company. All rights reserved.

Terms Of Use

Privacy Policy

All Products

About Our Ads

Children's Privacy Policy

All Articles

Cookie Consent Tool

Do Not Sell My Personal Information

All Educational Resources

CogniFit Blog: Brain Health News

Brain Training, Mental Health, and Wellness

Rhotacism: A complete guide to this speech impediment

Remember when you were a child and spoke by making your “R’s” sound like “W’s” and everything thought it was cute? That’s known as rhotacism and some people live with it even as adults. What is rhotacism, what is it like in other languages, and what are its symptoms? What does it look like as a speech impediment and what are some examples? What are its causes? How does it affect the brain ? Is it curable and how can it be fixed? This article will answer all your doubts about rhotacism. 

What is rhotacism?

Rhotacism is a speech impediment that is defined by the lack of ability, or difficulty in, pronouncing the sound R . Some speech pathologists, those who work with speech impediments may call this impediment de-rhotacization because the sounds don’t become rhotic, rather they lose their rhotic quality. It could also be called a residual R error.

It’s not such an uncommon phenomenon and actually also happens with the letter L , a phenomenon known as lambdacism . Sometimes people mistake these speech impediments for a lisp, of which they are not. Within the 2000-2001 school year, more than 700,000 students within the American public school system were categorized as having either a language impediment or a speech impediment. Ironically, all three speech impediments contain the troubled letter within them.

The word rhotacism comes from the New Latin rhotacism meaning peculiar or excessive use of [r]. The Latin word came from Ancient Greek word rhōtakismós which means to incorrectly use “rho” which is the equivalent of the Greek R. For language nerds, here’s a really great explanation of how the word came into being.

How does rhotacism work in different languages?

Rhotacism is, in theory , more common among people whose native language has a trilled R. For example, in Spanish the “rr” is a trilled R. Other languages with a trilled R include Bulgarian, Hungarian, Arabic, Finnish, Romanian, Indonesian, Russian , Italian, and most Swedish speakers. Some people might mock Asians, specifically Chinese, for not being able to pronounce the English word “broccoli” correctly- rather pronouncing it “browccoli”. This isn’t due to a rhotacism, however. It’s actually due to the fact that Mandarin (Chinese) words can have an “r” sound in the beginning of a word, but not in the middle or end of a word. This leads them to have issues in their phonotactics and creates an inability to pronounce the English “R” in the middle of words.

The leader of Hezbollah, Hasan Nasrallah, is a Lebanese leader and is mocked for his rhotacism when he says, “ Amwīka ” and “ Iswā’īl ” for the Arabic Amrīka (America), and Isrā’īl (Israel). He is a native Arabic speaker- a language which has the trilled R. Notice how he puts a W sound in those two words where the R sound usually is.

Symptoms of rhotacism

• Some people try to hide their impediment by avoiding words with R ’s in them.
• An overall inability to say R sounds
• Using trilled R’s or guttural R’s (such as the French R) when trying to pronounce the regular English R.

Rhotacism as a speech impediment

Using a strict classification, only about 5%-10% of the human population speaks in a completely normal way. Everyone else suffers from some type of speech disorder or another. For children of any language, the R sounds are usually the hardest to master and often end up being the last ones a child learns. That’s why baby talk if you think about it, doesn’t really use explicit or strong R sounds. In English, rhotacism often comes off as a W sound which is why “Roger Rabbit” sounds like “Woger Wabbit”. R is often more difficult because a child has to learn the different combination of the /r/ sounds, not just the letter itself, unlike other letters. For example, when it comes before and after vowel sounds. The combination of a vowel with the /r/ sound is called a phenome and in English, there are eight combinations of these:

–        The prevocalic R , such as “rain”

–        The RL , such as “girl”

–        The IRE, such as “tire”

–        The AR, such as “car”

–        The EAR , “such as “beer”

–        The OR , such as “seashore”

–        The ER , such as “butter”

–        The AIR , such as “software”

A speech impediment is a speech disorder , not a language disorder . Speech disorders are problems in being able to produce the sounds of speech whereas language disorders are problems with understanding and/or being able to use words. Language disorders, unlike speech disorders, have nothing to do with speech production.

Often what happens is that the person speaking isn’t tensing their tongue enough, or not moving their tongue correctly (up and backward depending on the dialect) which makes the W or “uh” sound come out. It may also be that the person is moving their lips instead of their tongue.

Examples of rhotacism

• Barry Kripke from the TV show The Big Bang Theory has both rhotacism and lambdacism- meaning he has issues pronouncing both his R ’s and his L ’s.
• The most famous of rhotacism would be Elmer Fudd from Looney Tunes . He pronounces the word “rabbit” [ˈɹ̠ʷæbɪ̈t] as “wabbit” [ˈwæbɪ̈t]
• In Monty Python’s Life of Brian , the 1979 film’s character Pilate suffers from rhotacism. In the film, people mock him for his inability to be understood easily.

Here’s a video with a woman who suffers from rhotacism. She explains how difficult it can be to have the speech impediment.

Causes of rhotacism

For many people, the causes of rhotacism are relatively unknown-, especially in adults. However, scientists theorize that the biggest cause is that the person grew up in an environment where they heard R ’s in a weird way, the shape of their mouths are different than normal, or their tongues and lips never learned how to produce the letter. In children, this could happen because the parents or adults around think the way the child talks (using baby talk) is cute and the child never actually learns how to produce it.

For one internet forum user, it has to do with how they learned the language , “I speak various languages, I pronounce the “R” normal in Dutch, French, and Spanish, but I have a rhotacism when speaking English. It’s the way I learnt it.”

For other people, speech issues are a secondary condition to an already existing, serious condition. Physically, it would be a cleft lip or a cleft palate. Neurologically, it could be a condition such as cerebral palsy. It may also be a tongue tie . Almost everyone has a stretch of skin that runs along the bottom of their tongue. If that skin is too tight and reaches the tip of the tongue, it can make pronouncing (and learning how to pronounce) R ’s and L ’s difficult. If the tongue tie isn’t fixed early on, it can be incredibly difficult to fix and learn how to pronounce later.

How the brain affects rhotacism

The brain affects rhotacism only for those who suffer from it not due to a physical impediment (such as a cleft palate). For some, this could happen because the brain doesn’t have the phonemic awareness and never actually learned what the letter R is supposed to sound like. This is common with kids whose parents spoke to them in “baby talk” and encouraged the child’s baby talk, too. This kind of behavior only strengthens a child’s inner concept that / R / is pronounced like “w” or “uh”.

Another reason could be that the brain connections simply don’t allow the lips or mouth to move in the way they need to in order to pronounce the R . This inability has little to do with physical incapabilities and more to do with mental ones. Some people with rhotacism have an issue with their oral-motor skills which means that there isn’t sufficient communication in the parts of the brain responsible for speech production.

Treatment for rhotacism

Is rhotacism curable.

It can have negative social effects- especially among younger children, such as bullying, which lowers self-esteem and can have a lasting effect. However, if the impediment is caught early enough on and is treated rather quickly, there is a good overall prognosis meaning it’s curable.

        However, some people never end up being able to properly pronounce that R and they end up substituting other sounds, such as the velar approximant (like w sounds) , the uvular approximant (also known as the “French R ”), and the uvular trill ( like the trilled R in Spanish).

How to fix rhotacism

Rhotacism is fixed by speech therapy . Before anything else, there needs to be an assessment from a Speech Language Pathologist (SLP) who will help decide if the problem can be fixed. If a child is involved, the SLP would predict if the child can outgrow the problem or not. After the diagnosis, a speech therapist will work with the person who suffers from the speech impediment by possibly having weekly visits with some homework and practice instructions. Therapy happens in spouts- a period of a few weeks and a break. There is a follow-up to see if there has been an improvement in pronunciation. In the U.S., children who are in school and have a speech disorder are placed in a special education program. Most school districts provide these children with speech therapy during school hours.

Another option, often used alongside speech therapy, is using a speech therapy hand-held tool that helps isolate the sound being pronounced badly and gives an image of the proper tongue placement to enable better pronunciation.

One study tested a handheld tactical tool (known as Speech Buddies) and the traditional speech therapy methods. The study found that students who used the hand-held tool (alongside speech therapy) improved 33% faster than those who used only the traditional speech therapy methods.

Have you or someone you know ever struggled with rhotacism? Let us know what you think in the comments below!

• Category: Wellness
• Tag: language , Language Disorder

• Overcoming Anxiety At Work: Steps to Promote Wellness Towards Successful Career

Pin It on Pinterest

Share this post with your friends!

Mobile Menu Overlay

The White House 1600 Pennsylvania Ave NW Washington, DC 20500

Remarks by President   Biden on Recent Events on College   Campuses

Roosevelt Room

11:07 A.M. EDT   THE PRESIDENT:  Good morning.   Q    Good morning.   THE PRESIDENT:  Before I head to North Carolina, I wanted to speak a few moments about what’s going on on our college campuses here. 

We’ve all seen the images.  And they put to the test two fundamental American principles. 

Excuse me.  (Coughs.)   The first is the right to free speech and for people to peacefully assemble and make their voices heard.  The second is the rule of law.  Both must be upheld.    We are not an authoritarian nation where we silence people or squash dissent.  The American people are heard.  In fact, peaceful protest is in the best tradition of how Americans respond to consequential issues.    But — but neither are we a lawless country.  We are a civil society, and order must prevail.    Throughout our history, we’ve often faced moments like this because we are a big, diverse, free-thinking, and freedom-loving nation.    In moments like this, there are always those who rush in to score political points.  But this isn’t a moment for politics.  It’s a moment for clarity.    So, let me be clear.  Peaceful protest in America — violent protest is not protected; peaceful protest is.  It’s against the law when violence occurs.    Destroying property is not a peaceful protest.  It’s against the law.   Vandalism, trespassing, breaking windows, shutting down campuses, forcing the cancellation of classes and graduations — none of this is a peaceful protest.    Threatening people, intimidating people, instilling fear in people is not peaceful protest.  It’s against the law.   Dissent is essential to democracy.  But dissent must never lead to disorder or to denying the rights of others so students can finish the semester and their college education.   Look, it’s basically a matter of fairness.  It’s a matter of what’s right.  There’s the right to protest but not the right to cause chaos.   People have the right to get an education, the right to get a degree, the right to walk across the campus safely without fear of being attacked.   But let’s be clear about this as well.  There should be no place on any campus, no place in America for antisemitism or threats of violence against Jewish students.  There is no place for hate speech or violence of any kind, whether it’s antisemitism, Islamophobia, or discrimination against Arab Americans or Palestinian Americans.   It’s simply wrong.  There is no place for racism in America.  It’s all wrong.  It’s un-American.    I understand people have strong feelings and deep convictions.  In America, we respect the right and protect the right for them to express that.  But it doesn’t mean anything goes.  It needs to be done without violence, without destruction, without hate, and within the law.   You know, make no mistake: As President, I will always defend free speech.  And I will always be just as strong in standing up for the rule of law.   That’s my responsibility to you, the American people, and my obligation to the Constitution.   Thank you very much.   Q    Mr. President, have the protests forced you to reconsider any of the policies with regard to the region?   THE PRESIDENT:  No. 

Thank you.   Q    Mr. President, do you think the National Guard should intervene?   THE PRESIDENT:  No.   11:11 A.M. EDT

Stay Connected

We'll be in touch with the latest information on how President Biden and his administration are working for the American people, as well as ways you can get involved and help our country build back better.

Opt in to send and receive text messages from President Biden.