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Speech Sound Disorders

Individual sounds serve as the basic units that comprise speech. Often times, a person may have difficulties acquiring particular sounds which may impact his or her intelligibility, or the degree to which that person is understood by others. Errors of speech sounds can be described as substitutions, omissions, distortions, and additions. Speech sound disorders are typically divided into articulation disorders (difficulty executing the muscular coordinations necessary to produce a specific sound or sounds) and phonological disorders (lack of understanding of the rules that govern the production and combination of speech sounds). Speech therapy has been demonstrated as an effective tool in improving or correcting these disorders.

Articulation refers to the production of the individual sounds of speech, including consonants and vowels. An articulation disorder arises when one has difficulty physically producing these sounds, potentially resulting in the substitution, omission, distortion, or addition of speech sounds. While there are various causes, articulation disorders in children are often due to a developmental delay or disorder. In some instances, though, children are simply “late” in producing sounds, and therapy helps get them on track. Adults can also experience articulation disorders. With adults, speech sound difficulties are often an acquired condition following a stroke or traumatic brain injury and/or a neurological condition such as dysarthria.

Phonology refers to the system of relationships between sounds within a language. An individual with a phonological disorder may not necessarily have difficulty physically producing a sound, but produces it incorrectly due to its relationship to other sounds being produced. For example, the word “cup” might be produced as “pup” due to a process known as “assimilation”, whereby one sound influences another sound in the word. Another example would be that all velar sounds (those that occur in the back of the mouth) such as “k” and “g” are instead produced in the front of the mouth. In this example, “cup” might be produced as “tup”. This process is known as “fronting”. Numerous different types of “phonological processes” exist by which an individual will produce sounds incorrectly due to deficits in his or her phonological system. Articulation and phonological disorders can, and often do, co-occur.

Apraxia of Speech is a specific disorder that causes difficulty in the sequencing of speech sounds. A great degree of motor planning is required in order to properly execute the correct sequence of sounds necessary to convey a message to a listener. Individuals with Apraxia of Speech will often produce speech sounds in an incorrect sequence and will do so on an inconsistent basis. For instance, the word “computer” may be produced as “tompucer” on the first attempt, “pomcuter” on the second attempt, and “pomtucer” on the third attempt. In this example, the speaker changed the order of the sounds with each production, demonstrating both incorrect and inconsistent sequencing patterns. Individuals with Apraxia of Speech tend to have greater success regarding rote sayings and expressions, such as “How are you?”, as compared to novel utterances that require conscious planning. Apraxia of Speech can be either developmental (arising during childhood) or acquired (appears after an incident or trauma). Apraxia of Speech can, and often does, co-occur with articulation and phonological disorders.

The presence of a cleft lip and/or palate can result in difficulty producing particular sounds in addition to affecting the overall resonance of the voice. Often, children with a palatal cleft will employ maladaptive compensatory strategies to articulate certain sounds which may lead to further medical issues. Even after the palate has been surgically repaired, they may continue to produce these compensatory strategies, making speech difficult to understand. Pre and post-surgical speech therapy can address the specific misarticulations of persons with cleft to facilitate correct articulatory placement. Clefts also affect the resonant qualities of a person’s voice, which is addressed in therapy as well.

Speech sound disorders are evaluated using conversational speech samples, oral reading, and production of individual words and sounds to gather a comprehensive representation of the client’s speech. In addition, a non-invasive oral-mechanism examination will be conducted to assess the structure and functioning of oral musculature and potential neurological involvement. A client and/or caregiver interview is included to gather relevant background information. After the initial consultation, the clinician will have a general understanding of the client’s stimulability. Understanding stimulability will predict how successful he or she will be in therapy, the specific tactics that will be most effective, and whether or not medical intervention is warranted.

We also offer comprehensive evaluations for those who would like an extensive report beyond that of the initial consultation. In addition to the components of the initial consultation, each evaluation will include assessment of related communication domains, an extended case-history, appropriate medical documentation, and communication with other professionals when appropriate. Prior to an evaluation, we will conduct a free 15-minute phone conversation to determine the assessment methodologies appropriate for you or your child’s concerns.

After the initial consultation or evaluation, the clinician will provide you with a treatment plan including a recommended frequency and total number of sessions. However, the frequency of sessions is at your discretion and amenable based on progress. Though most clients are seen for treatment once per week, a handful prefer or are recommended to receive more frequent sessions depending on severity, type of condition/disorder, and urgency to remediate the issue. We are happy to work with you to determine how many sessions will fit your specific needs. This can be adjusted at any time.

Therapy for speech sound disorders involves providing the client with the ability to auditorily discriminate correct sound productions, direct instruction of correct articulatory placement for sounds, exercises and strategies to facilitate sounds and sound combinations, and tactics to generalize correct sound production to conversational speech. All of this is accomplished within a caring and engaging atmosphere.

Clients with speech sound concerns are typically seen for therapy once per week for one hour. For young children, however, we recommend 30-minute sessions to maintain participation and satisfaction.