One of the most common questions I hear is
"why does my child have these speech sound difficulties?"
Sometimes it can be quite obvious why a child has difficulty with producing a particular sound or group of sounds (i.e. cleft lip/palate), other times a little more investigation is needed (i.e. hearing impairment). Sometimes there is no reason.
• Statistics are unclear but speech sound difficulties are estimated to occur in 2 to 25% of children aged between 5 and 7 years.
• Some children will resolve spontaneously and others will need intervention.
• Some children with speech sound difficulties also have language difficulties, some only have speech sound needs.
At initial assessment, we Speech and Language Therapists always take a case history to see if any of the information on the child’s past development and medical history might be relevant to the child’s current presentation to ensure that we can make an accurate diagnosis and prescribe the most effective intervention and plan of action for them.
It’s not always obvious and we cannot be 100% sure to link a speech sound difficulty to a root cause, but some of the more common factors that we see include the examples below.
Delayed Development
Some children are just a little later to acquire their speech sounds than their peers.
When we conduct our initial assessments, Speech Therapists always ask questions about the development of early milestones like sitting, crawling, walking, as well as when first words emerged. This can help us to see if there are patterns of delayed development for the child in more than one area.
For some children who were born prematurely, it’s a good idea to consider due date age as well as chronological age when looking at milestones during development, especially if they are under 5 years old. For example, you may have a child who was born 10 weeks early and has always been around 3 months delayed to meet their motor milestones. If you consider due date age, there’s very little delay at all. This is often reassuring for parents initially but always important to continue monitoring the child to ensure development occurs.
Hearing loss/glue ear (otitis media)/excess wax/foreign objects in ears
Yes, you read that right- foreign objects.
One child I worked with actually had a pea in their ear. And it had been there for quite a while! Yuck!
Many children develop glue ear and there are strong links in the evidence base to glue ear impacting on speech sound development.
Some of the common difficulties we see are with flowy sounds like S and F (you can read more about the different types of speech sounds here.
Poor language environment
There may not be much face-to-face time with a grown up and this means the child isn’t easily able to see sounds being made and modelled by adults.
Think of times where parents are busy on their phones or devices and talking to their child at the same time.
There may not be a lot of communication between parent/carer and child, spoken communication can be reduced to conversations with only 2 or 3 exchanges, there might be fewer opportunities for talking and communicating in the home environment or when out and about with parents.
Sometimes home environments can be incredibly busy, with lots of people interacting and living together that time to sit and chat may be hard to come by.
There may not be time for bedtime stories where lots of rhyming words and expressive sounds like “ooh” “pop” “wow” are encouraged through shared enjoyment of the book.
Sometimes older siblings can be a little too helpful and younger siblings don’t need to do as much talking or don’t get the chance to before another person talks for them or over them.
Sometimes parents have unresovled speech sound difficulties and this can be unintentionally passed on to the child through their communication and language modelling. This is less common.
Dummy user/thumb sucker
Lots of sounds are made on the alveolar ridge.
This is the part of the hard palate just behind the top teeth. Here we make the T, D, N, L, S,Z, SH, CH, J. Have a go at saying these sounds and think where the tip of your tongue goes to make these noises.
Now suck your thumb and try those sounds again. Not so clear is it?
So, if some children are using a dummy while they are talking, habits can form where substitute sounds are used, resulting in unclear speech.
I've written a searate article about dummies, their impacts on speech sound development and tips for getting rid of them in a different post, you can find it by clicking here.
Genetic or medical condition
Sometimes there is an underlying condition that the child has which can be a cause or comorbid issue with the speech sounds.
These may be dysarthria, cerebral palsy, Down syndrome, brain injury, craniofacial conditions, movement and coordination conditions.
Physical or structural abnormalities (talk cleft here but also mention tongue tie)
Children with Cleft lip, palate or both fall into this category.
Thinking again about the list of sounds above that are made on the ridge behind the top teeth, this will be an incredible challenge for children with cleft conditions and they will likely be under the care of a Specialist Speech and Language Therapist for ongoing intervention and monitoring.
Other physical or structural considerations are tongue tie.
This refers to the thick band of tissue that connects the bottom of the tongue to the floor of the mouth. Theorists love to argue whether this contributes to speech sound difficulties or not, but I’ve seen strong evidence in my clinical practise that it can, however it depends on the individual child or person.
If you are unsure, refer the child to a Speech and Language Therapist for further investigation.
Family history of Speech Language and Communication Needs
Has anyone else in the family seen a Speech Therapist?
Perhaps an older sibling also had speech sound difficulties. Maybe a parent or close family relative was late with their talking too.
It’s not always a certainty but we can sometimes see patterns in families with a history of speech, language and communication difficulties.
More than one language
A child may be using English as an additional language and some of the speech sounds used in one language are not present in the other.
Have you ever learned another language?
Can you remember how some of the speech sounds are different to the ones you use in your mother tongue?
Some sounds like the SH and Ch sounds in English just don’t feature in some other languages so these could be tricky for the child (and their parents).
Other conditions/impairments
There are some other conditions and impairments that children might have which has caused their speech sound difficulties.
This is another thing that a Speech Therapist will look at during initial assessment to support diagnosis.
Sometimes there’s no obvious cause.
For some children there’s not any cause for their speech sound difficulties, they just have them.
The best thing is that most speech sound difficulties can be resolved, or at least clarity can be improved for the vast majority of children we work with.
If all of this is interesting to you, you can find out more about speech sound development, causes, how to tell if there’s a problem, how to help children on different steps of their treatment and fun interventions you can do in your setting I have created an online course for you. Click here for more information.
If you’d like a downloadable tool to record and monitor the speech sound development of children in your setting, click here to learn more about my Speech Sound Screener.
Click on the picture above for more information.
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