Speech sound disorder

Also called SSD, Articulation disorder, Phonological disorder, Speech delay

A child whose sounds are still wrong past the age they should be: the difference between a mouth that can't make the sound and a brain that's filed it in the wrong place.

What it is

Speech sound disorder is the umbrella term for difficulty producing or organising the sounds of speech beyond the age at which most children have them. Language may be fine; the child knows the words. It's the sounds within them that are missing, swapped or distorted, so that "cat" is "tat" and "spoon" is "poon" well after the age at which that's expected.

Two things sit inside the umbrella. Articulation difficulties are physical: the mouth can't make the sound, as with a lisp. Phonological difficulties are about the sound system: the mouth can make the sound, but the child's rules for where sounds go are still immature or unusual. Phonological delay has its own entry because it's the commonest and the most treatable.

Who it can help

Children whose speech is hard for people outside the family to understand at three, or who still have several sound errors at five, and the parents who've been told "they'll grow out of it" and aren't sure. Most do improve, and the ones who don't need help early because speech sounds and reading are built on the same foundation.

It's the wrong entry for a child who understands little or says little; that's language, covered under DLD. And for inconsistent, groping errors, see childhood apraxia of speech.

How it works

Sounds arrive in a rough order, and the page on speech sound ages gives it. A child using patterns typical of a younger child is delayed; a child using patterns that no younger child uses (dropping all the sounds at the start of words, for instance) has a disorder, and the distinction changes the therapy.

Articulation therapy teaches the mouth position for one sound at a time and practises it in syllables, words, phrases and conversation. Phonological therapy works on the contrast between sounds so the child hears why "tea" and "key" need to be different, using minimal pairs, and change often generalises across many words at once.

Some children's difficulties have a physical cause worth ruling out: glue ear that muffles sounds during the years they're being learned, or a cleft palate. Hearing is always checked first.

Getting started

Ask the health visitor, nursery or GP for a speech and language therapy referral and a hearing test at the same time. While you wait, don't correct: say the word back clearly and carry on ("Yes, a cat!"). Face to face, slowly, with the sound the therapist names slightly emphasised.

Play listening games: which of these two pictures did I say? Sound-level work fits naturally into phonics at home, and a phonics keyboard that says each grapheme as the child taps it links the sound to the letter they're learning at school.

If the child is being teased or won't talk in class, tell the teacher; the confidence loss does more harm than the lisp.

Where to get help

NHS speech and language therapy through the GP, health visitor or school; the RCSLT explains the route and what to expect. Speech and Language UK has a parent helpline and age-by-age information, and Afasic supports families with any speech or language difficulty.