Patient Care

Speech Sound (Articulation) Disorders (Children)

What are Speech Sound (Articulation) Disorders?

Speech sound disorders are conditions where a child's articulation or pronunciation is delayed or deviant from normal speech sound development. There are five types of speech sound disorders:

  1. Organic speech sound disorder
    Articulation problems that are associated with structural abnormalities or known impairments such as cleft lip and palate, hearing impairment or brain injury.

  2. Functional speech disorder
    Difficulties in learning to make specific speech sounds.

  3. Developmental phonological disorder
    Difficulties using appropriate speech patterns. E.g. "tar" for "car" or "dock" for "sock"

  4. Developmental apraxia of speech
    Difficulties planning and coordinating lips, tongue, and jaw to produce speech sounds.

  5. Developmental dysarthria
    Motor speech disorder involving problems with strength and control of the speech musculature. Dysarthria is typically seen in children with cerebral palsy, traumatic brain injury, etc.

What are the causes of Speech Sound (Articulation) Disorders?

The precise causes for functional speech disorders, developmental phonological disorders and developmental apraxia of speech are unknown.

Developmental dysarthria is caused by impaired nerve and muscle function.

Some conditions such as cleft palate, hearing impairment, certain syndromes, tongue-tie, paediatric stroke will affect a child's clarity of speech.

What are the signs & symptoms of Speech Sound (Articulation) Disorders?

A child with a speech disorder may have one or more of these signs and symptoms:

  • Omissions or deletions
    Definition: Certain sounds are not produced but omitted or deleted.
    Examples: "boo" for "book" and "soon" for "spoon"

  • Substitutions
    Definition: One or more sounds are replaced with a different sound.
    Examples: "bat" for "pat", "dood" for "good" and "wabbit" for "rabbit"

  • Additions
    Definition: One or more sounds are added or inserted into a word.
    Examples: "buhlack" for "black" or "doguh" for "dog"

  • Distortions
    Definition: Sounds are altered or changed.
    Examples: An interdental "s" whereby the "s" sound is being produced with the tongue sticking out in between teeth

  • Syllable-level errors
    Definition: A syllable is repeated or deleted.
    Examples: "dada" for "dad" or "te_phone" for "telephone"

  • Prosody errors
    Definition: Inappropriate use of stress, intensity, rhythm, and intonation during speech

How are Speech Sound (Articulation) Disorders diagnosed?

An assessment by a speech therapist is necessary to determine the type of speech disorder(s) a child with unclear speech has. Other medical or allied health professionals may also need to be involved in the assessment and management.

What are treatment options of Speech Sound (Articulation) Disorders?

Each speech disorder requires a different type of treatment, and each treatment programme is individually tailored to the needs of the particular child.

Parents play an important role in their child's therapy which continues outside of the clinical setting. This includes practising the recommended speech strategies and activities with the child at home and following up on therapy visits regularly.

What are some tips for taking care of children with Speech Sound (Articulation) Disorders?

Children typically learn to produce different speech sounds gradually. Below is a general guide of speech sound development (consonant sounds):

  • By 2 years old: p, m, h, n, b, w, y, d
  • By 3 years old: t, k, g, f, ng
  • By 4 to 5 years: sh, s, j, ch, l, r, z
  • By 6 years and above: v, th, st, sp, sl, and other groups of consonant blends

All children make predictable pronunciation errors when they learn to speak like adults. A child will generally have speech that is normally clear:

  • 25- percent of the time by 18 months
  • 50- to 75- percent of the time by 24 months
  • 75- to 100- percent of the time by 36 months
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