Phonological disorder

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.

Causes

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.

  Cleft palate

  Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth.

   

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• 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 ).

  Cerebral palsy

  Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking...

   

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Symptoms

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 )

  Intellectual disability

  Intellectual disability is a condition diagnosed before age 18 that includes below-average intellectual function and a lack of skills necessary for d...

   

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• Hearing impairment
• Neurological conditions (such as cerebral palsy )

  Cerebral palsy

  Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking...

   

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• 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.

Treatment

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.

Outlook (Prognosis)

The outcome depends on the age at which the disorder started, and how severe it is. Many children eventually develop almost normal speech.

Possible Complications

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