A. Persistent difficulty with speech sound production that interferes with speech intelligi- bility or prevents verbal communication of messages.
B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement. or occupational performance, individually or in any combination.
C. Onset of symptoms is in the early developmental period.
D. The difficulties are not attributable to congenital or acquired conditions, such as cere- bral palsy, cleft palate. deafness or hearing loss, traumatic brain injury, or other medi- cal or neurological conditions.
Speech sound production describes the clear articulation of the phonemes (i.e., individual sounds) that in combination make up spoken words. Speech sound production requires both the phonological knowledge of speech sounds and the ability to coordinate the movements of the articulators (i.e., the jaw, tongue, and lips,) with breathing and vocalizing for speech. Chil- dren with speech production difficulties may experience difficulty with phonological knowl- edge of speech sounds or the ability to coordinate movements for speech in varying degrees
Speech sound disorder is thus heterogeneous in its underlying mechanisms and includes pho- nological disorder and articulation disorder. A speech sound disorder is diagnosed when speech sound production is not what would be expected based on the child’s age and devel- opmental stage and when the deficits are not the result of a physical, structural, neurological, or hearing impairment. Among typically developing children at age 4 years, overall speech should be intelligible, whereas at age 2 years, only 50% may be understandable.
Language disorder, particularly expressive deficits, may be found to co-occur with speech sound disorder. A positive family history of speech or language disorders is often present.
If the ability to rapidly coordinate the articulators is a particular aspect of difficulty, there may be a history of delay or incoordination in acquiring skills that also utilize the articulators and related facial musculature; among others, these skills include chewing, maintaining mouth closure, and blowing the nose. Other areas of motor coordination may be impaired as in developmental coordination disorder. Verbal dyspruxia is a term also used for speech production problems.
Speech may be differentially impaired in certain genetic conditions (e.g., Down syn- drome, 22q deletion, FoxPZ gene mutation). If present, these should also be coded.
Learning to produce speech sounds clearly and accurately and learning to produce con- nected speech fluently are developmental skills. Articulation of speech sounds follows a developmental pattern, which is reﬂected in the age norms of standardized tests. It is not unusual for typically developing children to use developmental processes for shortening words and syllables as they are learning to talk, but their progression in mastering speech sound production should result in mostly intelligible speech by age 3 years. Children with speech sound disorder continue to use immature phonological simplification processes past the age when most children can produce words clearly.
accurately according to age and community norms by age 7 years. The most frequently mis- articulated sounds also tend to be learned later, leading them to be called the ”late eight" (I, r, s, 2, th, ch, dzh, and zh). Misarticulation of any of these sounds by itself could be considered within normal limits up to age 8 years. When multiple sounds are involved, it may be appro- priate to target some of those sounds as part of a plan to improve intelligibility prior to the age at which almost all children can produce them accurately. Lisping (i.e., misarticulating sibi- lants) is particularly common and may involve frontal or lateral patterns of airstream direc- tion. It may be associated with an abnormal tongue—thrust swallowing pattern.
Most children with speech sound disorder respond well to treatment, and speech dif- ficulties improve over time, and thus the disorder may not be lifelong. However, when a language disorder is also present, the speech disorder has a poorer prognosis and may be associated with specific learning disorders.
Normal variations in speech. Regional, social, or cultural/ethnic variations of speech should be considered before making the diagnosis.