Short Description or Definition
Articulation disorders involve difficulty with the correct production of speech sounds. Within the literature, articulation disorders are often differentiated from phonological disorders in that articulation disorders involve motor movements, while phonological disorders refer to the underlying rules/patterns of sound production within a language.
Articulation disorders often are classified in terms of severity (e.g., mild, moderate, severe). This rating is typically based on the type/number of errors the individual produces relative to age/developmental norms, as well as a measure of overall intelligibility.
Shriberg et al. (1999) reported the prevalence of speech delay in a large sample of 6-year-olds to be 3.8% with a male-to-female ratio of 1.5:1. The comorbidity of speech delay and language impairment was reported to be 1.3%. However, estimates of the prevalence of speech sound disorders within the general population have been reported to be as high as 10%.
Natural History, Prognostic Factors, and Outcomes
Within the pediatric population, outcomes for individuals with articulation disorders range considerably depending on the severity of the disorder and the presence of other co-occurring conditions. For children who have been diagnosed strictly with articulation disorders, evidence suggests that with research-supported intervention, many speech sound disorders can be remediated.
Clinical Expression and Pathophysiology
Articulation disorders are typically characterized by the atypical development or production of a speech sound or group of speech sounds that result in a reduction in intelligibility. An articulation disorder is not the result of a cultural or dialectal difference. Disorders may include sound substitutions, distortions, additions, or omissions that impact an individual’s ability to be understood in conversation. Speech sounds may be incorrectly produced due to incorrect placement of articulators, imprecise voicing, and/or structural deficits of the larynx, lips, tongue, palate, teeth, and/or jaw.
Evaluation and Differential Diagnosis
Articulation disorders are assessed using standardized tests as well as observational measures. Examples of formal assessments of articulation abilities include the Arizona Articulation Proficiency Scale, Third Edition (Fudala 2000); Clinical Assessment of Articulation and Phonology, Second Edition (Secord et al. 2002); and the Goldman-Fristoe Test of Articulation,Third Edition (Goldman and Fristoe 2000). In addition to standardized measures, samples of speech taken in single word and conversational contexts can be used to determine the type of speech sound errors that are present. Speech sampling procedures may include the assessment of a child’s overall phonetic inventory (i.e., the number and variety of sounds he or she is able to produce), an analysis of syllable shapes and phonetic complexity and an analysis of error patterns. Stimulability measures (i.e., gradually prompting and shaping sounds using cues and feedback from the clinician) often are used to determine if the individual is able to produce the sound given maximal support. In addition to these procedures, best practice suggests that a complete oral-motor examination of the individual be completed to determine if there are any structural or motor function deficits that are impeding correct speech sound production.
Additionally, articulation disorders typically are differentiated from phonological disorders. Careful assessment of a child’s speech patterns may reveal not only a difficulty with speech sound production (i.e., a phonetic disorder) but also difficulties with the patterns of use of sounds within the language (see Phonological Disorders).
There are a variety of treatment approaches that are used for the management of articulation disorders. Once an individual’s specific areas of deficit have been determined, best practice would target the area of need that would most benefit the individual’s intelligibility (i.e., how easily his or her speech is understood). Depending on the nature of the problem, treatment may involve individualized speech therapy in which the individual is taught how to produce the sound correctly through demonstration and repeated practice, learning specific techniques to shape how the speech mechanism is used. Additional techniques that are often used include training in recognizing correct and incorrect productions so that the individual can monitor how his or her speech sounds and practicing in contexts that increase in complexity.
References and Reading
- American Speech-Language-Hearing Association, ASHA. (1993). Definitions of communication disorders and variations. ASHA, 35(Suppl. 10), 40–41.Google Scholar
- Bleile, K. (1995). Manual of articulation and phonological disorders: Infancy through adulthood. San Diego: Singular.Google Scholar
- Fudala, J. B. (2000). Arizona articulation proficiency scale (3rd rev.). Los Angeles: Western Psychological Services.Google Scholar
- Gierut, J. (2008). Treatment efficacy summary: Phonological disorders in children. Available from http://www.asha.org/public/EfficacySummaries.htm
- Goldman, R., & Fristoe, M. (2000). The Goldman-Fristoe test of articulation (2nd ed.). Circle Pines: American Guidance Service.Google Scholar
- Secord, W., Donohue, J., & Johnson, C. (2002). Clinical assessment of articulation and phonology. Greenville: Super Duper Publications.Google Scholar
- Secord, W., Boyce, S., Donahue, J., Fox, R., & Shine, R. (2007). Eliciting sounds: Techniques and strategies for clinicians (2nd ed.). Albany: Thomson Delmar Learning.Google Scholar