Speech Sound Disorders
Including Articulation (specific sounds) and Phonological Processes (sound patterns)

Defined: An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you. Not all sound substitutions and omissions are speech errors. Instead, they may be related to a feature of a dialect or accent. A phonological process disorder involves patterns of sound errors.

Major Categories of Phonological Processes:

Substitution Processes – This is a group of phonological processes in which one class of sounds is substituted for another.

This may include:

• Gliding (i.e. wamp for 'lamp', yejow for 'yellow', and wabbit for 'rabbit')
• Velar fronting (i.e. tup for 'cup' or dive for 'give')
• Stopping (when a fricative 'f,v,s,z,sh,voiced and voiceless th, h, zh'
  is replaced with a stop 'p,b,t,d,k,g') as in dip for 'ship'
• Backing (i.e. cop for 'top' or gog for 'dog')

Assimilation Processes – The production of dissimilar phonemes sound alike.

This may include:

• Reduplication – when a person repeats a patter (i.e. wawa for 'water')

• Regressive assimilation – when a later occuring sound effects an earlier sound (i.e. guck for 'duck'), progressive.
• Assimilation – when an earlier sound effects a later occuring sound (i.e. bip for 'zip').
• Voicing assimilation – when all consonants become voiced (i.e. bad for 'pad').
• Devoicing assimilation – when all consonants become unvoiced (i.e. pik for 'pig').

Syllable Structure Processes – These processes affect the structure of entire syllables, not just certain sounds.

This may include:
• Unstressed or weak-syllable deletion – involves omission of an unstressed syllable (i.e. mado for 'tomato'),
• Final-consonant deletion – when the final consonant of a word is omitted (i.e. pa for 'pat'),
• Epenthesis- when a schwa vowel is inserted between the consonants in an initial cluster (i.e. tuhree for 'tree'),
• Consonant-cluster reduction or simplification- when a consonant or consonants in a cluster are deleted (i.e. peed for 'speed'), and Metathesis – the production of sounds in a word in reversed order, i.e. ephelant for 'elephant')

Language Disorders – Including Expressive Language and Receptive Language

Defined: An expressive language disorder/delay is when an individual has limited oral language, difficulty with grammar (syntax, semantics, pragmatics), and/or inadequate social communication. A receptive language disorder/delay is when an individual has limited comprehension skills, deficient nonverbal communication skills, deficient literacy skills and difficulty using language appropriately based on the environment.

Expressive Language Disorder/Delays:

This may include:

• Limited mean length of utterance
• Difficulty with morphology (word structure)
• Deficient semantic (vocabulary) skills
• Difficulty with age appropriate syntax (word order within sentences)
• Difficulty forming thoughts into cohesive, complete sentences (verbal or written)

Receptive Language Disorder/Delays:

This may include:
• Deficiency with age appropriate comprehension skills (i.e. difficulty answering Who, What, When, Where, Why questions)
• Word finding difficulties
• Difficulty understanding body language (nonverbal language skills)
• Difficulty with higher order cognitive skills (i.e., problem solving, time management, working memory, etc).

Pragmatic Language Disorder/Delays Difficulty using appropriate language based on the current social situation.

This may include:
• Topic initiation
• Turn taking
• Topic maintenance
• Appropriate conversational repair strategies
• Discourse and narrative skill
• Staying relevant during conversation
• Difficulty understanding various emotions

Fluency Disorders:

Defined: Fluent speech is smooth, relatively easy and flowing. Nonfluent or stuttered speech is effortful and contains excessive dysfluencies.

Characteristics of fluent speech:
• Produced with relative ease and less tension.
• Flowing smooth Continuous
• Relatively rapid
• Normally rhythmic
• Does not contain excessive amounts of word or phrase repetition.

Characteristics of non-fluent speech:
• Contains prolongations (audible and nonaudible).
• Contains sound/part word/whole word/phrase repetitions.
• Contains audible blocks.
• Contains frequent pause breaks.
• Rephrasing or restarting multiple sentences.
• Speech contains numerous filler words/interjections (i.e. 'this, that, um, uh,' etc).
• Physical concomitants (i.e. facial grimaces, grouping).
• Development of secondary behaviors (i.e. clicking, rocking, lack of eye contact).

Voice Disorders: Including Vocal Pitch, Volume, and Quality. 

Defined: Optimal voice production is based upon intact anatomy and physiology of the larynx and surrounding structures. The human voice undergoes certain changes throughout the lifespan; between birth and death, everyone experiences vocal changes. Vocal Pitch
The frequency at which the vocal folds vibrate.

Pitch is determined by mass, tension and elasticity of the vocal folds (Higher pitch is generally when vocal folds are thinner, more tense or both).

Volume:
• Also known as intensity or loudness.
• Lung capacity can effect a speaker’s volume.

Quality: Also known as complexity of the laryngeal tone.

Characteristics may include:
• Hoarseness- breathy, low-pitched, and husky quality
• Harshness- rough, unpleasant, and gravelly sounding
• Stain-Strangle- labored, effortful, tense sounding
• Breathiness- occurs when the vocal folds do not fully touch during verbalizations, soft sounding and limited vocal range

Developmental Milestones for Speech and Language
Adapted from Guidelines-Roles and Responsibilties of the School-Based speech-Language Pathologist, American Speech-Language Hearing Association (2000)
This information is based on monolingual speaking children.

1 year
Recognizes his or her name.
Understands simple instructions.
Initiates familiar words, gestures, and sounds.
Uses ‘mama, dada,’ and other common nouns. 

1 1/2 year
Uses 10 to 20 words, including names.
Recognizes pictures of familiar persons and objects.
Combines two words, such as ‘all gone.
Uses words to make wants known, such as ‘more,’ ‘up.’
Points and gestures to call attention to an event and to show wants.
Follows simple commands.
Imitates simple actions.
Hums, may sing simple tunes.
Distinguishes print from non-print.
Understands simple questions and comments.

2 years
Identifies body parts.
Carries on conversations with self and dolls.
Asks 'what' and 'where.'
Has sentences length of two to three words.
Refers to self by name.
Names pictures.
Uses two-word negative phrases, such as ‘no want.’
Forms some plurals by adding ‘s.’
Has about a 300 word vocabulary.
Asks for food and drink.
Stays with one activity for 6 to 7 minutes.
Knows how to interacts with books (right side up , page turning from left to right).

2 ½ years
Has about a 450 word vocabulary.
Gives first name.
Uses past tense and plurals.
Combines some nouns and verbs.
Understands simple time concepts, such as ‘last night,’ ‘tomorrow.’
Refers to self as ‘me’ rather than name.
Tries to get adult attention with ‘watch me.’
Likes to hear same story repeated.
Uses ‘no’ or ‘not’ in speech.
Answers ‘where’ questions.
Uses short sentences, such as ‘me do it.’
Holds up finger to tell age.
Talks to other children and adults.
Plays with sounds of language. 

3 years
Knows night and day.
Matches primary colors; names one color.
Begins to understand prepositional phrases as ‘put the block under chair.’
Practices by talking to self.
Knows last name, sex, street name, and several nursery rhymes.
Tells a story or relays an idea.
Has sentence length of three or four words.
Has vocabulary of nearly 1,000 words.
Consistently uses m, n, ng, p, b, h, and w.
Draws circle and vertical lines.
Sings songs.
Stays with one activity for 8 to 9 minutes.
Asks ‘what’ question. 

4 years
Point to red, blue, yellow, and green.
Identifies crosses, triangles, circle and square.
Knows ‘next month,’ ‘next year,’ and ‘noon.’
Has sentence length of four to five words.
Asks ‘who’ and ‘why.’
Begins to use complex sentences.
Correctly uses m, n, ng, p, f, h, w, y, k, b, d, and g.
Stays with an activity for 11 to 12 minutes.
Plays with language (e.g. word substitutions). 

5 years
Defines objects by their use and tells what they are made of.
Knows address.
Identifies penny, nickel, and dime.
Has sentence length of five to six words.
Has vocabulary of about 2,000 words.
Uses speech sounds correctly, with the possible exceptions being y, th, j, s/z, zh, and r.
Knows common opposites.
Understands ‘same’ and ‘different.’
Counts 10 objects.
Uses future, present, and past tenses.
Stays with one activity for 12 to 13 minutes.
Questions for information.
Identifies left and right hand on self.
Uses all types of sentences.
Shows interest and appreciation for print. 

6-7 years
Identifies most sounds phonetically.
Forms most sound-letter association.
Segments sounds into smallest grammatical units.
Begins to use semantic and syntactic cues in writing and reading.
Begins to write simple sentences with vocabulary and spelling.
Appropriate for age.
Uses these sentences in brief reports and creative short stories.
Understands time and space concepts, such as before/after, second/third.
Comprehends mathematical concepts, such as ‘few,’ ‘many,’ ‘all' and ‘except.’

8, 9, 10, 11 years
By second grade, accurately follows oral directions for actions and thereby acquires new knowledge.
Substitutes words in oral reading, sentence recall,and repetition; copying and writing dictation are minimal.

Comprehends reading materials required for various subjects, including story problems and simple sentences. 

By fourth grade, easily classifies words and identifies relationships, such as ‘cause and effect;’defines words (sentence context); introduces self appropriately; asks for assistance.

Exchanges small talk with friends.
Initiates telephone calls and takes messages.
Gives direction for games; summarizes a television show or conversation.
Begins to write effectively for a variety of purposes.
Understands verbal humor. 

11, 12, 13, 14 years
Displays social and interpersonal communication appropriate for age.
Forms appropriate peer relationships.
Begins to define words at an adult level and talks about complex processes from an abstract point of view; uses figurative language; organizes materials.
Demonstrates good study skills.
Follows lectures and outlines content.

Adolescence and young adult
Interprets emotions, attitudes, and intentions communicated by others’ facial expressions and body language.

Takes role of other person effectively.
Is aware of social space zones.
Displays appropriate reactions to expressions of love, affection, and approval.
Compares, contrast, interprets, and analyzes new and abstract information. 

Source: from the ASHA Guidelines: Roles and Responsibilities of the School-Based Speech-Language Pathologist , 1999/III-303-305. Ohio Statewide Language Task Force. (1990). Developmental milestones: Language behaviors, In Ohio Handbook for the Identification, Evaluation and Placement of Children with Language Problems (1991). Columbus: Ohio Department of Education.

Editor’s Note:
These milestone are variable due to individual differences and variance in the amount of exposure to oral and written communication.