Understanding Speech Sound Disorder

Speech sound disorder is the name of a condition listed for the first time in 2013 in the Diagnostic and Statistical Manual of Mental Disorders, which doctors in the U.S. commonly use when diagnosing mental health problems in their patients. It replaces another condition, called phonological disorder, formerly listed in the Diagnostic and Statistical Manual. People with speech sound disorder have problems either making the sounds required to pronounce words or using sounds in their proper context. These problems qualify for a mental health diagnosis when they’re severe enough to interfere with important aspects of everyday life.

Speech Sound Basics

Speech sound-related problems come in two basic forms, known medically as articulation disorder and phonological disorder. Articulation is a term used to describe the ability to make the sounds needed to form words. When children begin learning how to use language, they commonly encounter age-appropriate articulation difficulties and are unable to make certain sounds until they develop the required muscle strength and muscle control. However, the American Speech-Language-Hearing Association reports, by the time a child reaches age 8, he or she should be able to make all of the sounds needed to speak clearly and correctly. Articulation disorder occurs when a child can’t produce the sounds appropriate to his or her age and compensates by doing such things as omitting sounds from words, substituting incorrect sounds for unpronounceable sounds, or adding additional sounds to words.

Phonological is a term that doctors and speech specialists use to describe issues related to the overall pattern of sound and word production.  People with phonological disorder have the physical ability to make the sounds required to form words, but repeatedly use those sounds out of context. In some cases, affected individuals replace the consonant sounds normally found in words with incorrect substitute sounds. In other cases, they omit certain consonant sounds altogether. As is true with articulation disorder, a person with phonological disorder must be old enough to be expected to make appropriate sound choices when forming words.

Potential Causes

Potential causes of articulation and phonological problems in a child include delayed or incomplete speech and language development, genetically inherited developmental problems, autism spectrum disorder, significant loss of normal hearing, brain injury and cerebral palsy or any other condition that damages the body’s nervous system function. However, in some cases, doctors can find no specific cause for a child’s failure to acquire age-appropriate articulation and phonological skills. Many adults affected by phonological and/or articulation problems are experiencing a continuation of symptoms that first appeared during their childhood years. However, some people acquire these problems during adulthood in the aftermath of a traumatic brain injury or a stroke.


A speech therapist (known technically as a speech-language pathologist) can help children and adults overcome their articulation- and phonology-related problems. In the case of articulation disorder, treatment approaches include such things as showing affected individuals how to make sounds properly, getting affected individuals to practice making difficult sounds on their own, and explaining the difference between appropriate and inappropriate sounds. In the case of phonological disorder, therapists typically teach their patients the fundamental laws that govern speech patterns.

Qualification as a Mental Health Concern

The American Psychiatric Association publishes the Diagnostic and Statistical Manual as a tool for mental health professionals who need to diagnose the symptoms that appear in their patients. For each condition, the manual provides a checklist of criteria that must be met before a doctor can make an official diagnosis. In order to qualify for a diagnosis, a person with speech sound disorder must meet two additional criteria above and beyond the presence of an articulation- or phonology-related speech problem. First, he or she must experience a significant disruption in the ability to participate in school, gain or maintain employment, or establish social relationships. In addition, if he or she has other physical or mental issues that contribute to difficulties with speech production, his or her symptoms must be worse than the problems typically produced by these issues.

Additional Considerations

The American Psychiatric Association created speech sound disorder as part of a reorganization and review process that took place before the publication of the fifth edition of the Diagnostic and Statistical Manual (DSM 5) in May 2013. In the fourth edition of the manual, the disorder (then identified as phonological disorder) appeared with a group of conditions specifically defined as occurring during infancy, childhood or adolescence. In recognition of the fact that adults can also develop the disorder, DSM 5 no longer explicitly links speech sound disorder to these early stages of life.

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