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Introduction
Speech disorders refer to a broad group of health-related conditions that disrupt the normal child’s speech. According to many sources, that is the most common reason a child needs to see a language therapist (Oliveira, Lousada, & Jesus, 2015; Ruscello, 2008). The prevalence of speech disorders differs from country to country but still remains very high. Considering the long-term consequences that speech disorders can possibly bring, they should be addressed with the help of interventions as soon as possible, regardless of their severity or the age, in which a child gets diagnosed.
Defining Speech and Phonological Disorders
The Definition of the Concept
The term speech disorder covers a varied group of conditions characterized by the difficulty in creating speech sounds, which an individual faces during the communication process. This group encompasses articulation and phonological disorders, voice disorders, disfluency, and so on (Kaneshiro, 2014b). This paper will focus mainly on phonological disorders. That is a condition when a person does not use (change, substitute, or miss) particular sounds and does not follow some speech rules of his or her native language, even though children are expected to acquire these skills naturally by a certain age (Kaneshiro, 2014a; Spivey, 2012).
Examples of Phonological Disorders
The phonological disorder can manifest itself in many ways. Most commonly, children change, substitute, or miss sounds that are too complicated for them to pronounce. As an example, kids often have difficulties with consecutive consonants; in this case, they just simplify words, skipping something: friend becomes fiend, truck becomes tuck, and so forth (Kaneshiro, 2014a; Spivey, 2012). Another example encompasses too complicated words with several syllables: nana instead of banana (Spivey, 2012, p. 1). Sometimes children also omit the endings: juice changes to joo, book changes to boo, etc. (Spivey, 2012, p. 1). The latter becomes even more complicated when it comes to the past tense with regular verbs or possessive and plural endings. Another common manifestation of the disorder is the substitution of one sound with another. The prime example is the difficulty with s, f, ch and sh; children tend to ignore those sounds and just use t instead: tin instead of chin, tire instead of fire, and so on (Spivey, 2012, p. 1).
When to Become Concerned?
Admittedly, almost all children face difficulties in forming correct speech sounds. That is normal since their speech is developing. However, all of those difficulties are expected to be overcome by a particular age. For example, when the child is growing, at first, his or her speech is only understood by parents or siblings and is not intelligible to a complete stranger. Still, by the age of three, all children are expected to develop their skills to such an extent that strangers can understand at least half of the words they say (Kaneshiro, 2014a, par. 3). By the age of five, more sounds should be understandable. However, the most difficult ones, such as s, z, r, ch, sh, and th can still be pronounced incorrectly even at the age of seven or eight (Kaneshiro, 2014a, par. 3).
According to Kaneshiro (2014a), if the child’s speech is too difficult to understand at the age of four, if he or she still misses or changes some sounds by seven, or if at any age the speech problems make a child embarrassed, it is better to see a speech-language pathologist (par. 8). Performing particular tests and analyzing how a child puts his or her words together, these specialists come up with the diagnosis and determine the treatment. The phonological disorder can be slight, mild, moderate, or severe (Spivey, 2012, p. 1).
The Prevalence of Speech Disorders in Different Countries and Languages
General Statistics
Speech disorders are the most common conditions that language therapists face (Oliveira et al., 2015, p. 174). As Ruscello (2008) states, more that 90% of speech-language pathologists that work in schools deal with exactly this kind of a disorder (p. 3). Approximately 10-15% of children at the pre-school age are diagnosed with these health conditions, and only a half of kids manage to get rid of those before the school age (Oliveira et al., 2015, p. 174). The majority of diagnosed have phonological disorders (Oliveira et al., 2015, p. 174). As for the gender, boys are more likely to face this problem than girls (Kaneshiro, 2014a, par. 2). Although many kids can develop normal language skills by themselves, more that 80% of diagnosed still require treatment services (Ruscello, 2008, p. 3).
Statistics by Countries
Evidently, the prevalence and statistics vary depending on the particular country and language. According to the study conducted by McLaughlin (2011) in the US, state Virginia, approximately 2.3-19% of children at the age from two to seven have speech and language disorders.
A lot of similar studies have been conducted in Brazil. Cavalheiro, Brancalioni, and Keske-Soares (2012) examined 2,880 children at the age of 4-6 years and found out that the prevalence of speech disorder was approximately 9% (p. 442). The highest prevalence had children at the age of five, and boys were almost three times more likely to be diagnosed (Cavalheiro et. al., 2012, p. 442). Another study reveals even higher values. According to Garcia de Goulart and Chiari (2014), 25% of 1,810 children had speech disorders.
In Australia, researchers received some results in this field as well. Eadie et al. (2015) say that only 3.4% of 1,494 participants at the age of four have been diagnosed with the speech disorder, with higher rates among boys (p. 578). Another study conducted in Australia gives higher percentages. McLeod and Harrison (2009) state that among 4,983 children at the age from four to five, there are approximately 25% of those, whose parents are concerned about the quality of their speech (p. 1220). Moreover, the majority of children have the manifestations of phonological disorders: the speech is not understandable to strangers (12%), the speech is not clear to the family members (6%) (McLeod & Harrison, 2009, p. 1220). Teachers have been concerned about 22.3% of the children (McLeod & Harrison, 2009, p. 1222).
According to the study conducted in the United Kingdom by Broomfield and Dodd (2004), the prevalence of speech disabilities is approximately 14.6% with the majority of diagnosed aged from 2 to 6 (p. 303).
All of the results are presented in the table below.
Additionally, it is interesting how speech disorders and phonological skills depend on the number of languages a child learns. Many people believe that bilingual children are more likely to have speech disorders since they can confuse two languages. However, Goldstein, Fabiano, and Washington (2005) prove the opposite. With 5 English-speaking, 5 Spanish-speaking and 5 bilingual participants, the authors show that there is no significant difference between children’s phonological skills, such as consonant and syllable accuracy, the number of substitutions, and so on (Goldstein et al., 2005, p. 214).
The Impact on Literacy, Psychology, and Communication
Speech disorders in general and phonological disorders in particular have many long-term consequences that make it imperative to address this problem at its early stages.
First of all, there is a threat to the education of a child. Since children with phonological disorders substitute and miss some sounds, as well as change and simplify the words greatly, they can face difficulties with spelling, reading, and writing in the future. As Ruscello (2008) states, some of them can even get diagnosed with learning disabilities (p. 3). That, in its turn, affects their performance in school and then in college or university. The study by Garcia de Goulart and Chiari (2014) reveals direct proportionality between the presence of the speech disorder and the school failure (p. 813). According to their words, pupils with disorders are nearly three times more likely to fail in school (Garcia de Goulart & Chiari, 2014, p. 813). McLaughlin (2011) confirms the same: speech disorders can result in impaired spelling and punctuation and an increased difficulty in reading (p. 1184).
However, that is not the only concern of phonological and other speech disorders. Even the mildest disorders can result in communication and social problems. Those can arise because the child’s speech is not understandable to others, and he or she can feel embarrassed about it. Such children usually passively participate in conversations with peers, do not initiate topics or invite others to conversations, rarely provide any new information, poorly and briefly reply to questions, etc. (Heward, 2010). All of this may result in the lack of communication and friends, excessive shyness, low self-esteem, self-doubt and so on. As Sices, Taylor, Freebairn, Hansen, and Lewis (2007) claim, speech disorders may contribute to various social and communication problems, as well as psychological ones, up to anxiety or depressions (p. 2). On the other hand, when children are not able to express themselves verbally, they may start doing it with their acts, which usually results in unpredictable and even inappropriate behavior. Additionally, disorders can also become the reason for bullying, especially if a particular problem with the speech is not overcome until relatively adult years.
Therapy for Children with Phonological Disorders
Firstly, the child should be examined for additional health-related conditions since phonological disorder can be caused by other disorders, such as various neurological or cognitive problems, problems with hearing and physical disorders (Kaneshiro, 2014a, par. 4). If one of those is revealed, firstly, the treatment should address it. When dealing with phonological disorders only, speech sessions should be conducted. Admittedly, slight and mild forms of a disorder may disappear without any interventions, but those are still recommended. Therapy can be provided either in a group or individually with every patient, but according to Ruscello (2008), individual sessions and in-home treatment work much better than group interventions (p. 6).
Before starting the treatment, a speech-language pathologist has to determine the details of the disorder, or in other words, how a child puts the sounds together. The SLT analyzes if a child misses the first word’s sound or the last one, if he or she has difficulties in pronouncing many syllables or many consonant, if it is hard for him or her to pronounce continuing sounds or those that should be produced at the back of the mouth, etc. (Spivey, 2012, p. 1). Considering all of this, the methods of therapy are chosen.
Phonological methods of intervention include many approaches. One of the most efficient and famous is the Modified Cycles Model. Each week the SLT trains a patient to pronounce only one or two sounds with the help of particular target words, and by the end of each week, the assessment of results is made. If a child can pronounce at least 20% of the target words correctly, then another sound or other sounds will be taught during the next week; otherwise, the same sounds and words will be worked on (CeronI, PagliarinII, & Keske-Soares, 2013, p. 191). Another method, called the Maximal Oppositions Approach, has also proven its efficiency. It helps a child to develop their speech skills using pairs of words that differ in only one phoneme, for example, sad-mad, sat-mat, and so on (CeronI et al., 2013, p. 191). These differences should be understood by the child. To get to the next level, he or she has to understand at least the half of the pairs selected for a section (CeronI et al., 2013, p. 191). The ABAB-Withdrawal and Multiple Probes Model is based on learning a complicated sound using a simpler one (CeronI et al., 2013, p. 191). In their study, CeronI et al. (2013) have proved the efficiency of these models and showed that those can address the phonological disorder regardless of its severity level or the age group of the participants. The only thing that has its effect on the result is the number of sessions: the more of them, the more sounds are learned, and the better results are observed.
To conclude, although speech disorders, including phonological ones, are very common among the children of pre-school and school age, and in many cases, they disappear without any interventions, these conditions should not be ignored. Regardless of the level of severity or the age at which a child faces this problem, if he or she feels embarrassed because of the disorder or if it has a negative influence on the communication process and the internal state of a child, it should be addressed as a matter of urgency. Speech disorders are fraught with many long-term consequences that can have an adverse impact on the rest of the child’s life.
References
Broomfield, J., & Dodd, B. (2004). Children with speech and language disability: caseload characteristics. International Journal of Language and Communication Disorders, 39(3), 303-324.
Cavalheiro, L. G., Brancalioni, A. R., & Keske-Soares, M. (2012). Prevalence of phonological disorders in children from Salvador, Bahia, Brazil. Revista da Sociedade Brasileira de Fonoaudiologia, 17(4), 441-446.
CeronI, M. I., PagliarinII, K. C., & Keske-Soares, M. (2013). Advances in the treatment of children with phonological disorders. International Archives of Otorhinolaryngology, 17(2), 189-195.
Eadie, P., Morgan, A., Ukoumunne, O. C., Eecen, T. K., Wake, M., & Reilly, S. (2015). Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children. Developmental Medicine & Child Neurology, 57(6), 578-584.
Garcia de Goulart, B. N., & Chiari, B. M. (2014). Speech disorders and grade retention in elementary. Revista CEFAC, 16(3), 810-815.
Goldstein, B. A., Fabiano, L., & Washington, P. S. (2005). Phonological Skills in Predominantly English-Speaking, Predominantly Spanish-Speaking, and Spanish-English Bilingual Children. Language, Speech, and Health Services in Schools, 36, 201-218.
Heward, W.L. (2010). Characteristics of Children with Communication Disorders. Web.
Kaneshiro, N. K. (2014a). Phonological disorder. Web.
Kaneshiro, N. K. (2014b). Speech disorders – children. Web.
McLaughlin, M. R. (2011). Speech and Language Delay in Children. American Family Physician, 83(10), 1183-1188.
McLeod, S., & Harrison, L. J. (2009). Epidemiology of Speech and Language Impairment in a Nationally Representative Sample of 4-to 5-Year-Old Children. Journal of Speech Language and Health Research, 52(5), 1213-1229.
Oliveira, C., Lousada, M., & Jesus, L. M. T. (2015). The clinical practice of speech and language therapists with children with phonologically based speech sound disorders. Child Language Teaching and Therapy, 31(2), 173-194.
Ruscello, D. M. (2008). Treating Articulation and Phonological Disorders in Children. St. Louis, MO: Mosby Elsevier.
Sices, L., Taylor, G., Freebairn, L., Hansen, A., & Lewis, B. (2007). Relationship Between Speech-Sound Disorders and Early Literacy Skills in Preschool-Age Children: Impact of Comorbid Language Impairment. Journal of Developmental & Behavioral Pediatrics, 28(6), 438-447.
Spivey, B. L. (2012). What are Phonological Disorders? Web.
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