speech difficulties Archives - AQM Speech & Language Therapy

What is a phonological process? Speech sounds are complex to say and sometimes little ones can have difficulty producing them accurately until they are more developed. They tend to replace these “tricky” sounds with ones that are easier for them to say. We call these substitutions phonological processes. Normally children will grow out of these by a certain age. Below is a guide for you on the most common phonological processes:

Substitution/process	Description	Example	Age when typical child stops process
Reduplication	When a complete (or incomplete) syllable is repeated	e.g. baba for bottle	Between 2 – 3 yrs
Affrication	When a non-affricate sound is replaced with an affricate(ch or j)	Joor for door	3 yrs
Final consonant deletion	When the last consonant in the word is left off	Child says “roe” instead of “road”	3 yrs
Fronting	When a sound normally produced at the back of the mouth is produced further forward in the mouth	Tup instead of cup	3 ½ yrs
Backing	When a sound normally produced at the front of the mouth is produced further back	Child says “gog” instead of “dog”	This is very unusual and when we observe this process it is often an indicator of a severe phonological difficulty
Stopping	When a fricative sound like f or s, or an affricate sound like ch or j is replaced with a plosive sound such as p or b	Stopping /f/ fish → tish Stopping /s/ soap → dope Stopping /v/ very→ berry Stopping /z/ zoo → doo Stopping ‘sh’ shop = dop Stopping ‘j’ jump → dump Stopping ‘ch’ chair → tare Stopping voiceless ‘th’ thing → ting Stopping voiced ‘th’ them → dem	3 yrs 3 yrs 3 yrs 6 months 3 yrs 6 months 4 yrs 6 months 4 yrs 6 months 4 yrs 6 months 5 yrs 5 yrs
Weak syllable deletion	When the weak syllable in a word is deleted	Banana becomes nana	4 yrs
Initial consonant deletion	When the initial sound is left off of the word	“bunny” → “unny”	This is very unusual and when we observe this process it is often an indicator of a severe phonological delay
Cluster reduction	when a consonant in a cluster of sounds is left out	“plane” → “pane”	4 yrs (without s) 5 yrs (in s clusters)
Gliding	When an r sound becomes a w or y sound and an l sound becomes a w or y sound	“robot” → “wobot” “yellow” →”lellow”	6 yrs

Cutting corners is a really bad thing

This has been on my mind for a while now so I thought I would say something about it. I came across a social media group for speech and language therapists and someone had posted a question about teaching a child to say the s sound. The child in question wasn’t able to make the sound without air escaping from her nose. So, the therapist wanted advice because what she was doing wasn’t working. I read the responses with interest. It is always good to see what other therapists do and the approach they take. A few therapists gave suggestions about different techniques to use, to see if it helped. Fortunately, many more all said the same thing (including me). The majority wanted to know if the child had had an oro-facial assessment and strongly advised referring the child to a specialist cleft, lip and palate clinic for further assessment.

The reason most of us recommended this is because speech difficulties can be caused by a variety of factors. Sometimes there is something different about the structure of the vocal tract. For example, the child has a tongue tie, has a cleft palate, or their velum isn’t working properly (that little piece that dangles down at the back of the throat). They may also have a condition such as dyspraxia or weak muscles which will impact on their speech. Sometimes, they just haven’t learned to say the sound properly, or learned to say it the wrong way when they were much younger and kept on doing it that way. The treatment methods for these difficulties will vary depending on its cause.

My point is that if you don’t know the cause then you can’t treat it properly. In fact you could make things worse by putting the child through ineffective, unnecessary therapy. Too often therapists don’t do an oro-facial assessment. An oro-facial assessment s when the therapist will look at a child’s face (for things like facial symmetry), look into their mouths, get them to say “ah” and then ask them to perform a series of tasks involving moving their tongue up and down, puffing out their cheeks etc.

I believe this to be a vital part of assessment and I always do one when assessing a child who has been referred for speech difficulties, but I am dismayed to find therapists that don’t and it causes me concern. I have seen patients who have been in treatment for a long time and never had one. I have performed this assessment with patients and discovered conditions such as a weak velum, that ultimately needed surgery.

I did some locum work for a neighbouring health trust and on my first day when being shown around my new clinic room, I asked where the alcohol gel and gloves were kept? The person giving me the guided tour ( a therapist) asked me why I needed them? I responded “for oro-facial assessments” and was told “oh we don’t really do them”!!!!! I kept my poker face on, but was so, so shocked. It is ingrained into every therapist at university that you should always perform one as part of your assessment. However, I have noticed increasingly that this is left out. Corners are cut and it is not good folks!!!

So, to every parent I say “please ask the clinician to do one if you are seen for speech difficulties”. To every therapist colleague of mine, I respectfully say “please, please don’t cut corners and leave this out, as you cannot treat someone effectively without a full understanding of what is occurring and you cannot gain a full understanding without performing an oro-facial assessment.

Thank you x

Category: speech difficulties

Phonological processes

Oro-facial assessments