Phonological disorderArticulation disorder; Developmental articulation disorder; Speech distortion; Sound distortion; Speech disorder - phonological
Phonological disorder is a type of speech disorder known as an articulation disorder.
Children with phonological disorder do not use some or all of the speech sounds expected for their age group.
This disorder is more common in boys.
The cause in children is often unknown. Close relatives may have had speech and language problems. Other risk factors may include poverty and coming from a large family.
Phonological disorders may also be caused by:
- Problems or changes in the structure or shape of the muscles and bones that make speech sounds. These changes may include cleft palate and problems with the teeth.
- Damage to parts of the brain or the nerves that control how the muscles and other structures work to create speech (such as from cerebral palsy).
In a child developing normal speech patterns:
- By age 3, at least one half of what a child says should be understood (intelligible) by a stranger.
- The child should make most sounds correctly by age 4 or 5, except for a few sounds such as l,s, r, v, z, ch, sh, and th.
- More difficult sounds may not be completely correct until age 7 or 8.
Children with phonological disorder have:
- Problems with words that begin with two consonants. "Friend" becomes "fiend" and "spoon" becomes "soon."
- Problems with words that have a certain sound, such as words with "k," "g," or "r." The child may leave out these sounds, not pronounce them clearly, or use a different sound in their place. (Examples include: "boo" for "book," "wabbit" for "rabbit," "nana" for "banana," "wed" for "red," and making the "s" sound with a whistle.)
These errors may make it hard for other people to understand the child. Only family members may be able to understand a child who has a more severe phonological speech disorder.
Exams and Tests
Children should be examined for disorders such as:
- Cognitive problems (such as intellectual disability)
- Hearing impairment
- Neurological conditions (such as cerebral palsy)
- Physical problems (such as cleft palate)
The health care provider should ask about issues, such as whether more than one language or a certain dialect is spoken at home.
Milder forms of this disorder may disappear on their own by around age 6.
Speech therapy may help for more severe symptoms or speech problems that don't get better. Therapy may help the child create the sound, for example, by showing where to place the tongue or how to form the lips when making a sound.
The outcome depends on the age at which the disorder started, and how severe it is. Many children eventually develop almost normal speech.
In severe cases, the child may have problems being understood even by family members. In milder forms, the child may have difficulty being understood by people outside the immediate family. Problems with social interaction and academic performance may occur as a result.
When to Contact a Medical Professional
Call your provider if your child is:
- Still difficult to understand by age 4
- Still unable to make certain sounds by age 6
- Leaving out, changing, or substituting certain sounds at age 7
- Having speech problems that are causing embarrassment
Kelly DP, Natale MJ. Neurodevelopmental function and dysfunction in the school-aged child. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 32.
Nass R, Sidhu R, Ross G. Autism and other developmental disabilities. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 90.
Review Date: 5/18/2016
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.