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Articulation refers to speech sound production. It is the process by which sounds, syllables and words are produced when the tongue, teeth, lips and palate manipulate the air stream coming from the vocal folds.

A person who has an articulation problem produces some speech sounds incorrectly, which makes it difficult for the listener to understand what is being said. Most articulation errors fall into one of three categories: omissions, substitutions, or distortions.


Omissions: Deletion of one or more sounds
“at” for “hat
“oo” for “shoe

Substitutions: Replacing one sound for another
replacing “r” sounds with “w” sounds:
“rabbit” sounds like “wabbit”
replacing “th” sounds for “s” sounds:
“sun” sounds like “thun”

Distortions: The sounds in a word are changed slightly, but can be recognized as the intended word.

Phonology is the sound system of language. The phonology of language tells us how sounds fit together in words. Children who have phonological processing disorders have not learned the rules for how sounds fit together to make words, and use certain processes to simplify words.


Fronting: substituting all sounds made in the back of the mouth such as “k” and “g” for sounds produced in the front of the mouth such as “t” and “d.”
Saying “tup” for “cup”
Saying “guck” for “duck”

Cluster Reduction: Omitting one of the sounds in a blend
Saying “poon” for “spoon” (omit the “s” sound)
Saying “boo” for “blue” (omit the “L” sound)

Using processes such as fronting and cluster reduction makes it difficult for the listener to understand what the speaker is trying to say. While some phonological processes are common in young children, it is not expected as the child gets older. If the child continues to use these or other simplification patterns for an extended period of time, the child may have a phonological disorder.

A speech disorder is when a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice.
A language disorder is when a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language).

Expressive language disorders refer to difficulties in the ability to communicate thoughts, needs, or wants at the same level or with the same complexity as his or her peers. Children with an expressive language disorder may have ability to understand complex spoken sentences and be able to carry out intricate instructions, but cannot form complex sentences. These children therefore usually speak in short simple sentences, using little or no descriptive words. The child often has a smaller vocabulary than his or her peers.

Receptive language disorders refer to difficulties in the ability to attend to, process, comprehend, retain, or integrate spoken language. A child with receptive language disorders may exhibit the following symptoms: - Inability to understand or follow directions
- Following of routine, repetitive directions may be OK
- Inappropriate, off-target responses to "wh" questions
- Difficulty responding appropriately to Yes/No questions
- Difficulty responding appropriately to either/or questions
- Not attending to spoken language

A Language delay is when a child’s language is developing in the right sequence, but at a slower rate

Oral Motor Disorders refer to any problem or deficiency in the Jaw, lip and tongue area. Disorders could include inability to initiate or coordinate movements of the articulators during either speech or eating, weakness in the oral area.

A child with an oral motor disorder may exhibit some of the following behaviors:
- trouble chewing, sucking, blowing, and/or making certain speech sounds
- Excessive drool
- Exhibits an “open mouth” posture
- Exhibits a protruding tongue

A fluency disorder is characterized by disruptions in smoothness, rhythm, and continuity of sounds, syllables, words or language during speaking. Prolongations (a drawn out sound or syllable), repetitions (repeating a sound, syllable, word or phrase), and/or blocks (unable to produce the desired sound) are the most common errors.

Stuttering is a disorder of speech fluency characterized by various behaviors that interfere with the forward flow of speech. The onset of this disorder usually occurs around the time that language skills are developing, and, in some cases, lasts throughout life. While all individuals are disfluent at times, what differentiates the person who stutters from someone with normal speech disfluency is the kind and frequency of disfluency, and/or the severity of their disfluency.

Stuttered speech is primarily characterized by repetitions (sounds, syllables, part-words, whole words, phrases), pauses, prolongations, and blocking of sounds. Secondary characteristics such as unusual facial expressions, motor behaviors, tics, embarrassment, anxiety, and avoidance of speaking or social situations are also frequently evident, and vary in type and severity.

Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language. It can occur suddenly, such as from a stroke or brain trauma, or slowly, as in the case of a brain tumor. Aphasia affects all modes of expressive and receptive communication including speaking, writing, reading, understanding and gesturing. The extent to which each of these is affected depends on the severity and location of the damage to the brain. Some may experience equal difficulty across modalities while others may experience more severe problems in one or more areas. Prognosis of recovery also varies. Some people may recover completely from aphasia while others may have permanent speech and language difficulties.

A Hearing impairment can be defined as an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance and requires specially designed instruction.

Hearing loss can be broken into two separate categories: conductive and sensorineural. These two labels define the location and characteristics of the hearing loss, and allow for accurate prognosis and course of treatment

Common causes of conductive hearing loss:
- Wax buildup
- Perforated eardrum
- Fluid in the ears
Common causes of sensorineural hearing loss:
- Noise exposure
- Age-related changes
- Ototoxic drugs

The inability or decreased ability to understand spoken language in a meaningful way is called central auditory processing disorder. This disorder is NOT related to or accompanied by hearing loss. People with CAPD cannot attend to, discriminate, recognize, or understand language that is presented to them auditorally (by listening). This affects language learning since most language is learned by listening. Difficulty in auditory processing can have a negative impact on a child's ability to function appropriately in school. Many challenges may be faced by the child including inability to attend in the classroom, difficulty distinguishing between important information and unimportant background noise, and increased frustrations with following even simple directions. A speech-language pathologist can evaluate a child's perception of speech and his/her receptive (understanding) and expressive (production) language use. An audiologist is also used to evaluate brain/neurological function in response to auditory output. Both speech-language pathologists and audiologists are instrumental in treatment of a child with CAPD.

Apraxia is a disorder of the nervous system that affects the ability to sequence and say sounds, syllables, and words. It is not due to muscular weakness or paralysis. The problem is in the brain's planning to move the body parts needed for speech (e.g., lips, jaw, tongue). The child knows what he or she wants to say, but the brain is not sending the correct instructions to move the body parts of speech the way they need to be moved. S.E.E.D.S. provides PROMPT Therapy as a therapeutic tool for this deficit.

Autism is a developmental disability that typically appears during the first three years of life. Autism impacts the normal development of the brain in the areas of social interaction and communication skills. People with autism also have a restricted amount of activities and interests. Children and adults with autism characteristically have difficulties in verbal and non-verbal communication, social interactions and leisure or play activities. It is hard for them to communicate with others and relate to the outside world. They may exhibit repeated body movements (hand flapping, rocking), unusual responses to people or attachments to objects and resist any changes in routines. In some cases, aggressive and/or self-inflicted harming behavior may be present.

For more information visit The National Center on Birth Defects and Developmental Disabilities

PDD is when there is an apparent impairment in the development of social interaction, including play skills, and/or verbal or nonverbal communication skills. Even though the child is having difficulties in socialization skills and communication, the criteria for a specific disorder (i.e. autism) are not all present.

Word finding difficulties refer to the ability to quickly and easily retrieve a particular word from memory. A word finding problem is the inability to quickly recall a word from memory even though the word is well known to the child. They appear not to know answers when in reality they know, but are unable to express their knowledge.

A traumatic brain injury (TBI) is the result of an injury to the head with may cause interference with normal brain function. Individuals with a brain injury often have cognitive and communication difficulties, that can significantly impact their ability to function. They vary according to the severity of the injury and the location of the trauma.

Any deviation in pitch, intensity, quality, or other basic vocal attribute which consistently interferes with communication.

- Common voice disorders include:
- Hoarse or breathy voice quality
- Vocal nodules
- Vocal fold paralysis

In order to be treated by a Speech-Language Pathologist, a prescription is needed by an Ear, Nose, and Throat Specialist (ENT).