Home > Diseases and Conditions > Phonological disorder
  • We are sorry, but NCBI web applications do not support your browser and may not function properly. More information

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Phonological disorder

Articulation disorder; Developmental articulation disorder; Speech distortion; Sound distortion

Last reviewed: June 12, 2012.

Phonological disorder is a type of speech disorder known as an articulation disorder.

Children with phonological disorder do not use some or all of the speech sounds expected for their age group.

Causes, incidence, and risk factors

This disorder is more common in boys. About 3% of preschool children and 2% of children ages 6 - 7 have the disorder.

The cause of phonological disorder in children is often unknown. Close relatives may have had speech and language problems. Other risk factors may include poverty and coming from a large family.

Phonologic disorders may also be caused by:

  • Problems or changes in the structure or shape of the muscles and bones that are used to make speech sounds. These changes may include cleft palate and problems with the teeth.
  • Damage to parts of the brain or the nerves that control how the muscles and other structures work to create speech (such as from cerebral palsy).

Symptoms

Most children have problems pronouncing words early on while their speech is developing.

However, by age 3, at least half of what a child says should be understood (intelligible) by a stranger.

By age 5, a child's speech should be mostly intelligible.

  • The child should make most sounds correctly by age 4 or 5, except for a few sounds such as l,s, r, v, z, ch, sh, and th.
  • Some of the more difficult sounds may not be completely correct, even by age 7 or 8.

Children with phonological disorder will substitute, leave off, or change sounds. These errors may make it hard for other people to understand the child. Only family members may be able to understand a child who has a more severe phonological speech disorder.

Commonly, children with this disorder have:

  • Problems with words that begin with two consonants. "Friend" becomes "fiend" and "spoon" becomes "soon."
  • Problems with words that have a certain sound, such as words with "k," "g," or "r." The child may either leave out these sounds, not pronounce them clearly, or use a different sound in their place. (Examples include: "boo" for "book," "wabbit" for "rabbit," "nana" for "banana," "wed" for "red," and making the "s" sound with a whistle.)

Signs and tests

Children should be examined for disorders such as:

  • Cognitive problems (such as intellectual disability)
  • Hearing impairment
  • Neurological conditions (such as cerebral palsy)
  • Physical problems (such as cleft palate)

The health care provider should ask about issues, such as whether more than one language or a certain dialect is spoken at home.

Treatment

Milder forms of this disorder may disappear on their own by around age 6.

Speech therapy may be helpful for more severe symptoms or speech problems that do not get better. Therapy may help the child create the sound, for example by showing where to place the tongue or how to form the lips when making a sound.

Expectations (prognosis)

The outcome depends on the age at which the disorder started, and how severe it is. Many children eventually develop almost normal speech.

Complications

In severe cases, the child may have problems being understood even by family members. In milder forms, the child may have difficulty being understood by people outside the immediate family. Problems with social interaction and academic performance may occur as a result.

Calling your health care provider

Call your health care provider if your child is:

  • Still difficult to understand by age 4
  • Still unable to make certain sounds by age 6
  • Leaving out, changing, or substituting certain sounds at age 7
  • Having speech problems that are making him or her worried or embarrassed at any age

References

  1. Friedman O, Wang TD, Milczuk. Cleft lip and palate. In: Flint PW, Haughey BH, Lund VJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Saunders Elsevier;2010: chap 186.
  2. Sharp HM, Hillenbrand K. Speech and language development and disorders in children. Pediatr Clin North Am. 2008;55:1159-1173. [PubMed: 18929058]
  3. Simms MD. Language disorders in children: classification and clinical syndromes. Pediatr Clin North Am. 2007;54:437-467. [PubMed: 17543904]
  4. Simms MD, Schum RL. Language development and communication disorders, In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 32.
  5.  

Review Date: 6/12/2012.

Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Electropalatography for articulation disorders associated with cleft palateElectropalatography for articulation disorders associated with cleft palate
    A cleft palate means that during the early stages of pregnancy, the baby’s roof of the mouth does not join in the normal way. The lip is sometimes cleft as well as the palate. Children who are born with a cleft lip or palate usually have corrective surgery during the first few years of life. Nowadays, surgery is so good that there are few long term consequences.
See all (5) ...

PubMed Health Blog...

read all...

MedlinePlus.gov links to free, reliable, up-to-date health information from the National Institutes of Health (NIH) and other trusted health organizations.