Articulation disorders are difficulties with the way sounds are formed and strung together, usually

characterized by substituting one sound for another (wabbit for rabbit), omitting a sound (han for hand),
or distorting a sound (ship for sip). The main characteristic of the disorder are:

Omissions - Sounds in words and sentences may be completely omitted. i.e. "I go o coo o the bu." for
"I go to school on the bus.".

Substitutions - Children do not pronounce the sounds clearly or they replace one sound for another.
I.e. substitutes [w] for [l] or [r], or other similar errors

Distortions - An attempt is made at the correct sound but it results in a poor production. i.e a
distorted /s/ sound may whistle, or the tongue may be thrusting between the teeth causing a frontal
lisp.

Additions - Extra sounds or syllables are added to the word. i.e animamal.

The most common error sounds are [s] [l] and [r].

The speech is primarily unintelligible and difficult to understand.

Articulation patterns that can be attributed to cultural or ethnic background are not disabilities.

Associated Features:

Developmental delay, is the cause of most articulation disorders. This can be the direct result hearing
problem. The child cannot hear the fine differences between sounds, so speech perception is inhibited.
Articulation disorders are also associated with overall delayed language development.

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to
differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.
An articulation problem sometimes sounds like baby talk because many very young children do
mispronounce sounds, syllables, and words.

Expressive Language Disorder.

Mixed Receptive-Expressive Language Disorder.
Phonological Disorder.
Apraxia of Speech.

Cause:

In many cases, there is not a clearly identifiable, structural or physiological reason for the problem.

Delayed Speech.
Hearing Impairment.
Mental Retardation.
Learning Disability.
Articulation problems may result from brain damage or neurological dysfunction, physical handicaps,
such as cerebral palsy, cleft palate or hearing loss. Or the condition may be related to lack of
coordination of the movements of the mouth, even dental problems. However, most articulation
problems occur in the absence of any obvious physical disability. The cause of these so-called functional
articulation problems may be faulty learning of speech sounds.

Treatment:

A speech evaluation should be performed by a speech-language pathologist. If there is a problem with

articulation that is not developmental in nature, speech therapy is recommended. Parent involvement is
necessary for the best progress and prognosis. The length of therapy can vary from 3 months to a
number of years, depending on the cause, the severity, the child's motivation, and parental support.

cleft lip

a small gap or an indentation of the lip due to the failure of fusion of the maxillary and medial nasal
processes

cleft palate

condition in which the 2 bones of the hard palate are not completely joined

appraxia of speech in adults

a motor programming disorder resulting from neurological damage; muscles are normal, but the signal
to the muscle is interrAphasia A complex speech and language impairment that results from a stroke
or brain injury. It is
more common in elderly people, and young children who develop aphasia are more likely to make a
more
full recovery dependent on the nature and extent of brain injury. Aphasia may also occur as a
component
of a disease that attacks brain tissue (e.g., tumors, dementia, etc.) There are several types of aphasia:

a. WERNICKE’S APHASIA (SENSORY APHASIA or FLUENT APHASIA) –

Difficulty understanding language because of the inability to hear words correctly. Speech may be
understandable, but utterances would be meaningless – words strung together seemingly at random.
Speech may be fluent, but the words may not be real (jargon).
b. MOTOR APHASIA (BROCA’S APHASIA or NON-FLUENT APHASIA) –
Difficulty speaking. Words are stuttered and halting. Articulation coordination is difficult.
c. ANOMIC APHASIA (AMNESIC APHASIA or NOMINATIVE APHASIA) –
Word-finding problems.
d. TRANSCORTICAL MOTOR APHASIA --
The ability to repeat words, name objects, and understand speech are preserved, but the person cannot
speak spontaneously.
e. CONDUCTION APHASIA –
Ability to speak spontaneously and name objects intact, but inability to repeat words.upted.

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak.
Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the
use of the tongue, ankyloglossia.

Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in
the center of the mouth. It is called a frenulum. After birth, the lingual frenulum continues to guide the
position of incoming teeth. As we grow, it recedes and thins. This frenulum is visible and easily felt if you
look in the mirror under your tongue. In some children, the frenulum is especially tight or fails to recede
and may cause tongue mobility problems.

The tongue is one of the most important muscles for speech and swallowing. For this reason having
tongue-tie can lead to eating or speech problems, which may be serious in some individuals.

Speech –
While the tongue is remarkably able to compensate and many children have no speech impediments
due to tongue-tie, others may. Around the age of three, speech problems, especially articulation of the
sounds - l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a
three–year–old child’ s speech is not understood outside of the family circle. Although, there is no
obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the
following associated characteristics are common:

 V-shaped notch at the tip of the tongue

 Inability to stick out the tongue past the upper gums

 Inability to touch the roof of the mouth

 Difficulty moving the tongue from side to side

As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or
lollipop without much difficulty. If the answer is no, they cannot, then it may be time to consult a
physician.

Appearance –For older children with tongue-tie, appearance can be affected by persistent dental
problems such as a gap between the bottom two front teeth. Your child’ s physician can guide you in the
diagnosis and treatment of tongue-tie. If he/she recommends surgery, an otolaryngologist—head and
neck surgeon (ear, nose, and throat specialist), can perform a surgical procedure called a frenulectomy.