speech impediment 4 year old

• 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.
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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

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

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

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

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

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

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

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

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

Can Symptoms Worsen?

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

Symptoms of dysarthria can include:

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

Symptoms of aphasia may involve:

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

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

Causes of Speech Impediment

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

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

Speech Impairment in Children

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

Common causes of childhood speech impediments include:

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

Do Childhood Speech Disorders Persist?

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

Speech Impairment in Adulthood

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

Common causes of adult speech impairment include:

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

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

Do Speech Disorders Resolve on Their Own?

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

Steps to Treating Speech Impediment 

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

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

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

Diagnostic testing may include:

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

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

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

Therapy to Address Speech Impediment

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

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

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

Exercises during speech therapy may include:

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

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

Building Confidence With Speech Problems 

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

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

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

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

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

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

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

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

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

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

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

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

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Speech Delays in 4 Year Olds

As your 4-year-old embarks on the exciting journey of language development, you might notice that their speech doesn’t quite match that of their peers. While every child progresses at their own pace, some may experience speech delays, which can raise concerns among parents. Understanding speech delays, their signs, and when to seek help is crucial for supporting your child’s communication skills and overall development. Let’s delve into the world of speech delays in 4-year-olds and empower you with the knowledge you need to navigate this important aspect of your child’s growth.

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What is a Speech Delay?

Definition of Speech Delay:

A speech delay refers to a slower-than-expected development of speech sounds, affecting a child’s ability to express themselves clearly and understandably. It’s important to differentiate speech delays from other language disorders, which encompass broader aspects of communication, such as grammar, vocabulary, and comprehension.

Importance of Identifying Speech Delays Early:

Early identification and intervention for speech delays are crucial for optimal outcomes. Addressing these delays early can help children catch up with their peers, improve their communication skills, and boost their confidence in social interactions.

Developmental Milestones for 4-Year-Olds

Typical Speech and Language Milestones at 4 Years:

By the age of 4, most children have achieved significant milestones in their speech and language development. They can typically:

• Engage in conversations using simple sentences and phrases.
• Ask and answer questions appropriately.
• Use a variety of vocabulary words to express their thoughts and ideas.
• Understand and follow multi-step instructions.
• Produce most speech sounds correctly.

Comparing with Previous Years’ Developmental Milestones:

Building upon the language skills acquired in earlier years, 4-year-olds exhibit more complex and nuanced communication abilities. They can engage in longer conversations, express their thoughts and feelings more clearly, and grasp more intricate concepts.

Indicators of Typical Speech Development:

If your child’s speech development falls within the typical range for their age, you should notice:

• Steady progress in their ability to express themselves verbally.
• Increasing clarity and articulation of their speech sounds.
• An expanding vocabulary that allows them to communicate their needs and desires effectively.
• Growing confidence in using language to interact with others.

Signs of Speech Delays in 4-Year-Olds

Common Signs of Speech Delay at 4 Years:

While every child develops at their own pace, some red flags may indicate a speech delay:

• Limited vocabulary compared to their peers.
• Difficulty forming complete sentences or using proper grammar.
• Mispronouncing or omitting words frequently.
• Appearing frustrated or unable to express themselves verbally.
• Relying on gestures or nonverbal cues instead of speaking.

Comparing with Typical Speech Development:

If your child’s speech development lags behind their peers, you may notice:

• They struggle to keep up with conversations or follow instructions.
• Their speech is difficult to understand due to unclear articulation or limited vocabulary.
• They seem frustrated or avoid communication situations.
• Their overall social and emotional development may be affected.

Common Causes of Speech Delays

Genetic and Hereditary Factors:

Speech delays can sometimes run in families, suggesting a possible genetic predisposition. If you or other family members have a history of speech delays, your child may be at an increased risk.

Underlying Medical and Neurological Conditions:

Certain medical conditions, such as hearing loss, cerebral palsy, or Down syndrome, can contribute to speech delays. Additionally, neurological disorders like autism spectrum disorder (ASD) may also impact language development.

Environmental and Parenting Factors:

Environmental factors, such as limited exposure to language or inconsistent communication patterns, can also influence speech development. Additionally, parenting practices that discourage or limit verbal interactions may hinder a child’s language skills.

When to Seek Professional Help

Indicators for Seeking Professional Help:

If you have concerns about your child’s speech development, it’s crucial to seek professional evaluation. Early intervention can make a significant difference in addressing speech delays and improving communication skills.

Importance of Early Intervention:

Early intervention for speech delays is highly beneficial. Children who receive timely support are more likely to catch up with their peers, develop clear speech, and enhance their overall language skills.

Types of Professionals to Consult:

If you suspect a speech delay, consult with your child’s pediatrician. They can assess your child’s development and refer you to appropriate specialists, such as speech-language pathologists (SLPs) or audiologists.

Diagnosis and Evaluation Process

Description of the Evaluation Process:

The evaluation process for speech delays typically involves:

• A comprehensive interview with parents: Gathering information about the child’s medical history, developmental milestones, and communication patterns.
• Observational assessments: Observing the child in various settings to understand their communication abilities.
• Standardized tests: Administering tests to evaluate the child’s speech and language skills.

Conclusion: Supporting Your Child’s Speech Development

Early identification and intervention are key to helping children with speech delays. By understanding the signs and seeking professional help, parents can ensure their child receives the support they need to thrive. Remember, every child develops at their own pace, and with the right guidance, they can overcome challenges and achieve their full potential.

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Speech Sound Disorders in Children

What are speech sound disorders in children?

It’s normal for young children learning language skills to have some trouble saying words the right way. That’s part of the learning process. Their speech skills develop over time. They master certain sounds and words at each age. By age 8, most children have learned how to master all word sounds.

But some children have speech sound disorders. This means they have trouble saying certain sounds and words past the expected age. This can make it hard to understand what a child is trying to say.  

Speech sound problems include articulation disorder and phonological process disorder.

Articulation disorder is a problem with making certain sounds, such as “sh.”

Phonological process disorder is a pattern of sound mistakes. This includes not pronouncing certain letters.

What causes speech sound disorders in a child?

Often, a speech sound disorder has no known cause. But some speech sound errors may be caused by:

Injury to the brain

Thinking or development disability

Problems with hearing or hearing loss, such as past ear infections

Physical problems that affect speech, such cleft palate or cleft lip

Disorders affecting the nerves involved in speech

Which children are at risk for speech sound disorders?

The cause often is not known, but children at risk for a speech sound disorder include those with:

Developmental disorders such as autism

Genetic disorders such as Down syndrome

Hearing loss

Nervous system disorders such as cerebral palsy

Illnesses such as frequent ear infections

Physical problems such as a cleft lip or palate

Too much thumb-sucking or pacifier use

Low education level of the parent

Lack of support for learning in the home

What are the symptoms of speech sound disorders in a child?

Your child’s symptoms depend on what type of speech sound disorder your child has. He or she may have trouble forming some word sounds correctly past a certain age. This is called articulation disorder. Your child may drop, add, distort, or swap word sounds. Keep in mind that some sound changes may be part of an accent. They are not speech errors. Signs of this problem can include:

Leaving off sounds from words (example: saying “coo” instead of “school”)

Adding sounds to words (example: saying “puhlay” instead of “play”)

Distorting sounds in words (example: saying “thith” instead of “this”)

Swapping sounds in words (example: saying “wadio” instead of “radio”)

If your child often makes certain word speech mistakes, he or she may have phonological process disorder. The mistakes may be common in young children learning speech skills. But when they last past a certain age, it may be a disorder. Signs of this problem are:

Saying only 1 syllable in a word (example: “bay” instead of “baby”)

Simplifying a word by repeating 2 syllables (example: “baba” instead of “bottle”)

Leaving out a consonant sound (example: “at” or “ba” instead of “bat”)

Changing certain consonant sounds (example: “tat” instead of “cat”)

How are speech sound disorders diagnosed in a child?

First, your child’s healthcare provider will check his or her hearing. This is to make sure that your child isn’t simply hearing words and sounds incorrectly.

If your child’s healthcare provider rules out hearing loss, you may want to talk with a speech-language pathologist. This is a speech expert who evaluates and treats children who are having problems with speech-language and communication.                       

By watching and listening to your child speak, a speech-language pathologist can determine whether your child has a speech sound disorder. The pathologist will evaluate your child’s speech and language skills. He or she will keep in mind accents and dialect. He or she can also find out if a physical problem in the mouth is affecting your child’s ability to speak. Finding the problem and getting help early are important to treat speech sound disorders.

How are speech sound disorders treated in a child?

The speech-language pathologist can put together a therapy plan to help your child with his or her disorder. These healthcare providers work with children to help them:

Notice and fix sounds that they are making wrong

Learn how to correctly form their problem sound

Practice saying certain words and making certain sounds

The pathologist can also give you activities and strategies to help your child practice at home. If your child has a physical problem in the mouth, the pathologist can refer your child to an ear, nose, throat healthcare provider or orthodontist if needed.

Spotting a speech sound disorder early can help your child overcome any speech problems. He or she can learn how to speak well and comfortably.

How can I help my child live with a speech sound disorder?

You can do things to take care of your child with a speech sound disorder:

Keep all appointments with your child’s healthcare provider.

Talk with your healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include experts such as speech-language pathologists and counselors. Your child’s care team will depend on your child’s needs and the severity of the speech sound disorder.

Tell others of your child’s disorder. Work with your child’s healthcare provider and schools to develop a treatment plan.

Reach out for support from local community services. Being in touch with other parents who have a child with a speech sound disorder may be helpful.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your child has:

Symptoms that don’t get better, or get worse

New symptoms

Key points about speech sound disorders in children

A speech sound disorder means a child has trouble saying certain sounds and words past the expected age.

A child with an articulation disorder has problems making certain sounds the right way.

A child with phonological process disorder regularly makes certain word speech mistakes.

The cause of this problem is often unknown.

A speech-language pathologist can help diagnose and treat a speech sound disorder.

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child’s condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Fluency Disorder

• Age-Appropriate Speech and Language Milestones
• Communication Disorders in Children

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Types of Speech Impediments

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Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

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

Cincinnati Children's Hospital. Stuttering .

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

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

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

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

How to Help a Kid With a Childhood Speech Impediment

Difficulties in speech that many call "speech impediments" are common as language develops. Just don’t wait too long to seek help.

It can be very frustrating for a child suffering from a speech impediment —be it stutter or lisp — to figure out how to join a conversation. Importantly, Speech-language pathologists practicing speech therapy don’t consider “speech impediment” to be a particularly helpful word. Speech is very complicated, requiring many skills to develop concurrently . The American Speech Language Association prefers the terms “speech delay” or “speech disorder,” both of which are fairly common.

“Speech includes how we pronounce or articulate the sounds in words, the quality of our voice, and the fluency or smoothness of delivery,” says to Melanie Potock, a pediatric speech pathologist, a feeding specialist, and the author of Adventures in Veggieland .

Dysfluencies in language – such as stuttering or repeating words or starting sentences over – may be a part of typical speech development as toddlers learn to produce these sounds. A child who may be difficult to understand when they first learn to string words into sentences will usually develop enough articulation over time to be understood. If they don’t, they may have an articulation delay or an articulation disorder.

“Delay refers to a gap in development. That stall or break in development may be mild or enough to cause concern,” explains Potock. “Children have an articulation disorder when testing shows that they are producing the sounds, syllables or words atypically when compared with other children of the same sex and age.”

Each child develops at their own pace, however, so it can be difficult to identify when typical dysfluencies become a problem. There can be a lot of factors for parents to look for, but Potock has identified some general red flags that might signal a serious issue.

Red Flags for Speech Impediments:

• Frustration : the child is frustrated by their inability to communicate. Biting, excessive whining, and tantrums may all be indicators of an inability to communicate wants and needs.
• Unintelligibility to strangers : neighbors and new friends don’t understand the child. Parents often learn to decipher developing speech patterns, but those unfamiliar with them will be confused
• Unintelligibility at home: even family members may not be able to understand a child with confusing word form, limited intelligibility, poor voice control or stuttering.
• They sound immature: parents shouldn’t compare their kids to other kids – but if other kids the same age sound more grown-up, parents may want to discuss the possibility of a speech delay with their pediatrician.
• Difficulty eating: early difficulties with feeding development may be an indicator of delays in oral motor skills and thus, directly related to speech and possibly language development.

“Parents should contact their child’s doctor to discuss the possibility of consulting with a certified speech-language pathologist if they are concerned about their child’s speech or language or notice any of the signs,” advises Potock. “Early intervention services for children birth to age 3 are available in every state in the U.S., and evaluations are free to low-cost, as is therapy, should the child qualify.”

A certified speech-language pathologist can make speech therapy fairly entertaining for a child, and it’s an excellent chance for socialization. There is some homework so parents can practice good habits at home with their child, but it’s similar to the sort of games many parents already play with their children – memory games, sorting games, and reading. If a parent suspects their child is struggling with language, they shouldn’t wait to see what happens before they bring it up with a pediatrician.

“Don’t wait,” cautions Potock. “The wider that gap grows, the longer the child will be in therapy. Parent proactively and talk to your child’s pediatrician about your concerns and he/she will guide you through the options.”

Health Library Speech Disorders

What is a speech disorder.

Many children will experience a temporary delay in speech and language development. Most will eventually catch up. Others will continue to have difficulty with communication development. Communication disorders include speech disorders and language disorders. Speech disorders are discussed in this article and some general guidelines are also given.  This will help you decide if your child needs to be tested by a speech-language pathologist.

A child with a speech disorder may have difficulty with speech sound production, voice, resonance or fluency (the flow of speech).

Speech Sound Disorders

A child with a speech sound disorder is unable to say all of the speech sounds in words. This can make the child’s speech hard to understand. People may not understand the child in everyday situations.  For most children, the cause of the speech sound disorder is unknown.  Other speech sound disorders can be linked to things such as a cleft palate, problems with the teeth, hearing loss, or difficulty controlling the movements of the mouth.

Reasons for Concern

• The child doesn't babble using consonant sounds (particularly b, d, m, and n) by age 8 or 9 months.
• The child uses mostly vowel sounds or gestures to communicate after 18 months.
• The child’s speech cannot be understood by many people at age 3.
• The child’s speech is difficult to understand at age 4 or older.

Voice Disorders

The voice is produced as air from the lungs moves up through and vibrates the vocal folds. This is called phonation. With voice disorders, the voice may be harsh, hoarse, raspy, cut in and out, or show sudden changes in pitch. Voice disorders can be due to vocal nodules, cysts, papillomas, paralysis or weakness of the vocal folds.

• The voice is hoarse, harsh or breathy.
• The voice is always too loud or too soft.
• The pitch is inappropriate for the child's age or gender.
• The voice often "breaks" or suddenly changes pitch.
• Frequent loss of voice

Resonance Disorders

Resonance is the overall quality of the voice. A resonance disorder is when the quality of the voice changes as it travels through the different-shaped spaces of the throat, nose and mouth. Resonance disorders include the following:

Hyponasality (Denasality): This is when not enough sound comes through the nose, making the child sound “stopped up.” This might be caused by a blockage in the nose or by allergies.

Hypernasality : This happens when the movable, soft part of the palate (the velum) does not completely close off the nose from the back of the throat during speech. Because of this, too much sound escapes through the nose. This can be due to a history of cleft palate, a submucous cleft, a short palate, a wide nasopharynx, the removal of too much tissue during an adenoidectomy, or poor movement of the soft palate.

Cul-de-Sac Resonance: This is when there is a blockage of sound in the nose, mouth or throat. The voice sounds muffled or quiet as a result.

Reasons for Concern:

• Speech sounds hyponasal or hypernasal
• Air is heard coming out of the nose during speech

Fluency Disorders (Stuttering)

Fluency is the natural “flow” or forward movement of speech. Stuttering is the most common type of fluency disorder. Stuttering happens when there are an abnormal number of repetitions , hesitations, prolongations, or blocks in this rhythm or flow of speech. Tension may also be seen in the face, neck, shoulders or fists. There are many theories about why children stutter. At present, the cause is most likely linked to underlying neurological differences in speech and language processing. Internal reactions from the person talking, and external reactions from other listeners, may impact stuttering, but they do not cause stuttering.

• The parents are concerned about stuttering.
• The child has an abnormal number of repetitions, hesitations, prolongations or blocks in the natural flow of speech.
• The child exhibits tension during speech.
• The child avoids speaking due to a fear of stuttering.
• The child considers themselves to be someone who stutters.

Treatment for Speech Disorders

Early intervention is very important for children with communication disorders. Treatment is best started during the toddler or preschool years. These years are a critical period of normal language learning. The early skills needed for normal speech and language development can be tested even in infants. At that age, the speech-language pathologist works with the parents on stimulating speech and language development in the home. Active treatment in the form of individual therapy usually starts between the ages of 2 and 4 years.

If you have concerns about your child’s communication skills, discuss them with your child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment.

All children with speech and language disorders should also have their hearing tested.

Helping Your Child

Children learn speech and language skills by listening to the speech of others, and practicing as they talk to others. Parents are the most important teachers for their child in their early years.

They can help the child by giving lots of opportunities to listen to speech and to talk. This can be done by frequently pointing out and naming important people, places, and things. They can also read and talk to the child throughout the day, especially during daily routines, interactive plays, and favorite activities. Parents can give the child models of words and sentences to repeat.

Parents can also set up opportunities for the child to answer questions and talk. Listening to music, singing songs and sharing nursery rhymes are also great ways to build speech and language skills while having fun with your child.

Last Updated 12/2023

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About Stuttering

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We all have times when we do not speak smoothly. We may add "uh" or "you know" to what we say. Or, we may say a sound or word more than once. These are called disfluencies.  

People who stutter may have more disfluencies and different types of disfluencies. They may repeat parts of words ( repetitions ), stretch a sound out for a long time ( prolongations ), or have a hard time getting a word out ( blocks ).

Stuttering is more than just disfluencies. Stuttering also may include tension and negative feelings about talking. It may get in the way of how you talk to others. You may want to hide your stuttering. So, you may avoid certain words or situations. For example, you may not want to talk on the phone if that makes you stutter more.

Stuttering can change from day to day. You may have times when you are fluent and times when you stutter more. Stress or excitement can lead to more stuttering.

The following typical disfluencies happen to many of us and are not stuttering:

• Adding a sound or word, called an interjection – "I um need to go home."
• Repeating whole words – " Cookies cookies  and milk."
• Repeating phrases – " He is–he is 4 years old."
• Changing the words in a sentence, called revision – " I had–I lost my tooth."
• Not finishing a thought – " His name is  . . . I can't remember."

When children are learning a lot of words or new speech sounds, you may notice some of these typical disfluencies. This is normal.

The following types of disfluencies happen when someone stutters:

• Part-word repetitions – "I w-w-w- want a drink."
• One-syllable word repetitions – " Go-go-go away."
• Prolonged sounds – " Ssssssss am is nice."
• Blocks or stops – "I want a (pause)  cookie."

You may also notice other behaviors like head nodding or eye blinking. Sometimes people who stutter use these behaviors to stop or keep from stuttering. They may also avoid using certain words or use different words to keep from stuttering.  

Feelings and attitudes can affect stuttering. For example, frustration or tension can cause more disfluencies. Being excited or feeling rushed can also increase disfluencies. A person who stutters may also stutter more if others tease them or bring attention to their speech. Stuttering may cause a person to be embarrassed and make them feel nervous about talking.

Stuttering usually starts between 2 and 6 years of age. Many children go through normal periods of disfluency lasting less than 6 months. Stuttering lasting longer than this may need treatment.

There is no one cause of stuttering. Possible causes include the following:

• Family history. Many people who stutter have a family member who also stutters.
• Brain differences. People who stutter may have small differences in the way their brain works during speech.

You cannot always know which children will continue to stutter, but the following factors may place them at risk:

• Gender. Boys are more likely to continue stuttering than girls.  Data are currently limited to individuals who identify as male or female.
• Age when stuttering began. Children who start stuttering at age 3½ or later are more likely to continue stuttering.
• Family recovery patterns. Children with family members who continued to stutter are also more likely to continue.

Seeing A Professional

If you think your child stutters, get help from an SLP as early as possible. Early help can reduce the chances that your child will keep stuttering. Contact an SLP if any of the following things happen:

• Your child's stuttering has lasted for 6–12 months or more.
• Your child starts to stutter late (after 3½ years old).  
• Your child starts to stutter more often.
• Your child tenses up or struggles when talking.
• Your child avoids talking or says it is too hard to talk.
• There is a family history of stuttering.

Testing For Stuttering

It's not easy to tell if your child stutters. Stuttering is more than disfluencies, so it is important to see an SLP for testing. The SLP will look at the following things:

• The types of disfluencies (typical and stutter-like).
• The number of disfluencies that are the stuttering type.
• How your child reacts when they stutter – do they get upset?
• How your child tries to "fix" their speech – do they start over or stop talking?

The SLP will ask if your child’s stuttering affects the way they play with others, or if stuttering makes it harder for them to participate in school. The SLP will use all of this information to decide if your child stutters or not.

The SLP will also test your child's speech and language. This includes how your child says sounds and words, how well they understand what others say, and how well they use words to talk about their thoughts.

Treatment For Stuttering

There are different ways to help with stuttering. A treatment team usually includes you, your child, other family members, and your child's teacher. Treatment will depend one or more of the following:

• How much your child stutters
• How your child reacts when stuttering
• How stuttering impacts your child's everyday life
• How others react to your child when they stutter
• Your child's age

Treatment For Preschool Children Who Stutter

For preschool children, treatment may include the use of direct or indirect strategies.

• Direct strategies help your child change how they speak.
• Indirect strategies are ways to help make it easier for your child to talk. These strategies can include slowing down your own speech and asking fewer questions. 

You are an important part of your child's treatment. The SLP can help you learn more about how to respond when your child stutters and what to do to improve how your child feels about talking.

Treatment For Older Children and Adults Who Stutter

For older children and adults, treatment focuses on managing stuttering. An SLP will help them feel less tense and speak more freely in school, at work, and in different social settings. The SLP will also help the person face speaking situations that make them fearful or anxious. This might include speaking on the phone or ordering food at a restaurant.

Some adults who started stuttering as a child may want to see an SLP every once in a while. The SLP will talk to the person about how stuttering affects their everyday life and can help the person practice ways to manage stuttering.

Children and adults who stutter may want to look into local support groups, where they can talk with others who stutter and learn about other helpful resources.

See ASHA information for professionals on the Practice Portal's Fluency Disorders page.

This list does not include every website on this topic. ASHA does not endorse the information on these sites.

• National Stuttering Association
• Stuttering Foundation of America
• American Board of Fluency and Fluency Disorders
• International Stuttering Association
• Stuttering Association for the Young
• Friends: The National Association of Young People Who Stutter
• Stuttering Home Page
• StutterTalk

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What Is a Lisp?

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

What Causes a Lisp?

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

Other possible causes of lisps include:

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

When Is Lisping a Concern?

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

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

Types of Lisps

There are four types of lisps:

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

Treatment for Lisps

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

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

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

How to Find a Speech-Language Pathologist

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

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

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

Other Types of Speech Impediments

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

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

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

Home Remedies to Help Lisps

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

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

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10 Warning Signs of a Speech Disorder In Your Child

10 Warning Signs of Speech Disorder in Your Child. What You Need to Know.

Would you be able to identify a speech disorder in your child?  If you are like most parents, the answer is No. As we delve into Better Hearing and Speech Month, we would like to point out 10 warning signs of speech speech disorder in your child. Of course, symptoms can vary depending on the specific speech condition of your child, but there are some essential signs that every parent should watch for as their children grow and develop.

What exactly is a speech disorder? According the American Speech-Language-Hearing Association , a speech disorder is when a person is unable to produce speech sounds correctly or fluently, or where normal speech is disrupted. Articulation disorders , speech impediment , and stuttering are examples of speech disorders. Both adults and children can suffer from speech disorders and they can occur as a result of a medical problem or have no known cause. Speech disorders involve difficulty in producing certain sounds such as “s”or “r”. As your child matures, his or her speech pattern should become more understandable and generally, he should be speaking clearly by the age of eight.  While all children develop at different rates, it’s important to ensure that your child is showing continuous language growth and progression.

10 Warning Signs of Speech Disorder in Your Child

• Your child does not interact socially starting in infancy
• He does not follow or understand what you say (starting at 1 year)
• She says only a few sounds, words, or gestures (18 months to 2 years)
• Her words are not easily understood (18 months to 2 years)
• She does not combine words (starting at 2 years)
• He has a limited vocabulary (age 2-3 years)
• She says p, b, m, h, and w incorrectly in words (1-2 years)
• She says k, g, f, t, d, and n incorrectly in words (2-3 years)
• He produces speech that is unclear, even to familiar people (2-3 years)
• He is not using 2-3 word sentences to ask for things (by 3 years)

If you think your child is exhibiting any of these warnings signs of speech disorder, it’s important to seek the advice of a pediatrician or speech language therapist. Early intervention is the key to prevention and elimination of a speech disorder at any age. For additional detailed information, The National Institute on Deafness and Other Communication Disorders (NIDCD) has an  online checklist available for parents who are concerned about their children’s speech and communication development.

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Top 10 Signs Your Child Has a Speech Disorder

Raleigh Capitol Ear, Nose and Throat Audiology , Communication Disorders , Pediatric ENT Services

All parents want to do everything in their power to ensure their sons and daughters have the best possible academic start in life. This involves researching the best schools, discovering the most reputable day cares, and providing toys that are educational as well as entertaining.

But how many parents watch for the early signs of a speech disorder?

If your child has a speech disorder, he or she is at a  greater risk of performing below grade level . This not only equates to problems reading and writing: speech disorders can devastate your child’s self-esteem, causing him or her to avoid school. The good news is speech therapy is incredibly successful! In order to achieve the maximum benefit though, your child should be treated as soon as signs of a speech disorder first appear.

Following are 10 signs that your child has a speech disorder and needs speech therapy:

1. your child stutters..

Stuttering is an obvious indication that your child needs speech therapy.  Children who stutter  may repeat whole words (He-he-he- ran to the door) or the first syllable of a word (j-j-jump).  Sometimes stuttering children may avoid talking altogether.

2. YOUR CHILD HAS AN INCONSISTENT VOICE QUALITY.

Not all signs of a speech disorder have to do with vowels or consonants. Often, children who have a  hoarse voice or inability to control volume  may need early intervention. They also may have trouble emphasizing the correct syllable of a word, even though they pronounce a word correctly (such as saying BA- NAN-A instead of ba-NAN-a).

3. YOUR CHILD DOESN’T INTERACT WITH OTHER CHILDREN.

If your baby doesn’t smile or show acknowledgement when someone is speaking or playing, you should consider scheduling an appointment with a speech therapist.

4. YOUR CHILD DOESN’T BABBLE.

Between four and seven months of age, your child should be babbling or making “nonsense” noises. These sounds are important because they will help your son or daughter learn words.

5. YOUR CHILD SHOWS SPEECH INCONSISTENCY.

For example, your child may pronounce a word correctly the first time but incorrectly the second or third time. They may also place gaps between syllables (run…ning).

6. YOUR CHILD HAS A CLEFT PALATE OR OTHER STRUCTURAL PROBLEMS WITH THE MOUTH.

Problems with the lips, jaw or tongue can make it difficult for children to speak clearly and consistently. This can have a devastating effect on their academic progress.

7. YOUR CHILD DOESN’T GESTURE.

Your child should be using gestures such as waving and pointing by the time he or she is seven to twelve months old.

8. YOUR CHILD DOESN’T SPEAK.

When your child doesn’t speak a lot – or at all – this is a red-flag warning. You should also be concerned if your child says fewer than 50 words by the time he or she is two years old.

9. YOUR CHILD HAS SEVERAL EAR INFECTIONS.

You may not equate ear infections with speech disorders, but extensive and chronic ear infections can cause fluid in the middle ear to cause temporary hearing loss. If this happens repeatedly, your  child’s speech may be delayed .

10. YOUR CHILD HAS SOME TYPE OF HEARING LOSS OR HEARING DISORDER.

In order to create sounds properly, your child needs to be able to hear them properly. Hearing loss, particularly in the early years, can cause more extensive speech problems further on down the line. If your child has even partial hearing loss, it’s important to work closely with an  audiologist speech therapist  to be sure he or she has all the skills needed to help them succeed in school and in life.

We can help your child overcome speech problems

Raleigh Capitol Ear, Nose and Throat offers a wide variety of voice and speech services including treatment for:

• Voice disorders
• Articulation and phonology – treatment designed to improve the dynamic production of specific sounds (e.g. /k/ in “cup”)
• Aural Rehabilitation for Children with Hearing Loss – treatment designed to assist individuals with auditory disabilities improve their communication
• Articulation and language disorders

We have the information you need

Following are some articles with extensive educational information on common communication disorders and how they are treated. We encourage you to  contact us to schedule an appointment  if you have questions or concerns.

How to Treat Stuttering in Children

Common Communication Disorders

You can also track your child’s progress by referring to these hearing development  milestones for infants  and  children .

Raleigh Capitol Ear, Nose, and Throat is the area’s premiere physician-owned ENT practice with six convenient locations throughout Wake County. Our board-certified physicians have extensive experience in treating both common and complex cases to help adults and children alike. For more information or to schedule an appointment, contact us.

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About speech and speech development

Speech is the ability to use your lips, tongue and other parts of your mouth to produce sounds.

For speech, children need to understand different sounds and the rules for putting those sounds together in their own language.

Most children master the following sounds at the following ages:

• around 3 years : b, p, m, n, h, d, k, g, ng (as in ‘sing’), t, w, f, y
• around 4-5 years : sh, zh, ch, j, s and cluster sounds tw, kw, gl, bl
• around 6 years : l, r, v and cluster sounds pl, kl, kr, fl, tr, st, dr, br, fr, gr, sn, sk, sw, sp, str, spl
• around 7-8 years : th, z and cluster sounds sm, sl, thr, skw, spr, skr.

Most children make mistakes in their speech during the first few years of speech development. But by about 3 years, most children can be understood by their main caregivers, siblings and peers.

Spotting speech disorders

If you’re concerned that your child might have a speech disorder, think about  how often people who don’t know your child have trouble understanding what your child says .

When a child is 2 ½ years old , an unfamiliar person should understand about half of what the child is saying.

When a child is 4-5 years old , an unfamiliar person should understand the child about three-quarters of the time. The child will probably still say some sounds and words differently from adults.

When a child is 6-7 years old , an unfamiliar person should understand almost everything the child says. The child might make some errors in the ‘th’ sound in words like ‘this’ or ‘that’. They might also have trouble saying longer words like ‘hippopotamus’.

Some speech disorders happen when a child has a physical problem like a  cleft palate , which makes it hard for the child to create the sounds of speech. Others have trouble because of  deafness or hearing loss . But most children have no specific reason for their speech disorder.

Speech disorders are different from  language delay . Children with speech disorders can understand words and sentences well and form phrases and sentences correctly. Children with language delay might use very few words for their age or not understand what you say.

When to get help for speech disorders

If your child has a speech disorder, you’ll probably need help from a professional.

It’s best to consider seeking help if your child:

• sounds very immature for their age or uses only a few speech sounds
• doesn’t pronounce words the way you’d expect for their age
• gets frustrated or upset when you don’t understand them, has to repeat sounds or stutters
• has hearing loss.

Where to get help for children’s speech

If you have any worries about your child’s speech development, it’s a very good idea to talk with your  GP ,  paediatrician or  child and family health nurse or your child’s teacher.

These professionals might refer you to a  speech pathologist , or you can visit a private speech pathologist yourself. You might be referred to an  audiologist if there’s a possibility that your child’s speech problems are caused by hearing loss.

How to help with children’s speech development

Young children typically pronounce words differently from adults. There’s no need to correct them every time they make a mistake.

If you want to encourage your child to form words the right way,  gentle reminders can help. For example, if your child says, ‘I saw the tat’, you could reply, ‘Where was the cat? What was the cat doing?’ This involves repeating the missing or different sound – ‘cat’ – with a slight emphasis.

If  your child’s speech is really hard to understand , here are some ideas for helping your child to communicate:

• Ask your child to show you what they’re talking about. For example, ask your child to point to the thing that they want.
• Ask simple questions to get more information about what your child is trying to say. For example, ‘Are you telling me about something that happened today? Did it happen at kinder?’ Then let your child tell you the rest of the story.
• Encourage your child to talk slowly. Let your child know you’re listening and that they can have as much time as they like to tell you.

What not to worry about with speech development

Although children might be able to make the right sounds, they might not use them correctly in words in the early years. And while they’re learning to talk, children simplify adult speech to make it easier to say.

This means  you probably don’t need to worry if your young child:

• substitutes sounds in words (‘lellow’ instead of ‘yellow’)
• simplifies difficult sound combinations (‘side’ instead of ‘slide’)
• drops syllables (‘puter’ instead of ‘computer’).

It’s OK if your 3-year-old is still doing these things, as long as you can understand what they’re saying. But if your child is making a lot of errors and you can’t understand what they’re saying, it’s a good idea to see a speech pathologist.

JEDDA RUPERT, MD, PAMELA HUGHES, MD, AND DANIEL SCHOENHERR, MD

Am Fam Physician. 2023;108(2):181-188

Patient information: See related handout on speech and language delay in children .

Author disclosure: No relevant financial relationships.

Childhood speech and language concerns are commonly encountered in the primary care setting. Family physicians are integral in the identification and initial evaluation of children with speech and language delays. Parental concerns and observations and milestone assessment aid in the identification of speech and language abnormalities. Concerning presentations at 24 months or older include speaking fewer than 50 words, incomprehensible speech, and notable speech and language deficits on age-specific testing. Validated screening tools that rely on parental reporting can serve as practical adjuncts during clinic evaluation. Early referral for additional evaluation can mitigate the development of long-term communication disorders and adverse effects on social and academic development. All children who have concerns for speech and language delays should be referred to speech language pathology and audiology for diagnostic and management purposes. Parents and caretakers may also self-refer to early intervention programs for evaluation and management of speech and language concerns in children younger than three years.

Speech is the verbal production of language. Language is the processing of a communication system. Receptive language includes an individual's comprehension abilities. Expressive language includes conveying ideas in spoken, written, or visual forms. 1

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