Some children may have difficulty saying certain sounds as they learn to talk. Some sounds are typically learned earlier (e.g., p, m, w) and other sounds take longer to learn (e.g., z, v, th). Most children say almost all sounds correctly by the age of 4. A child who is difficult to understand or who does not say sounds by expected ages may have a speech sound disorder. The terms “articulation disorder” and “phonological disorder” are used to describe difficulties producing specific sounds as well.

To learn more about what you should expect your child to be able to say, see these two resources:

ASHA’s Communication and Feeding Milestones: Birth to 5 Years

Your Child’s Communication Development: Kindergarten Through Fifth Grade

Speech therapy for children focuses on working on a child’s overall intelligibility by helping the child learn to produce age-appropriate speech sounds.  Therapy starts with production of each sound in isolation and builds toward producing words, sentences, and finally, application during conversation as appropriate for the child’s age.

A language disorder is characterized by a difficulty in listening and speaking skills impacting understanding and use of language. Much like speech, different components of language (e.g., using past tense, combining words) begin to emerge at different stages of a child’s development. Language disorders may persist across the life span, and symptoms may change over time. A spoken language disorder can occur in isolation or in the presence of other conditions. These children often additionally have difficulty learning to read and write or may have social communication difficulties due to an underlying impairment in language processing.

Language therapy frequently consists of providing a rich language environment, integrating reading and writing, addressing grammar, family training, and supporting expansion of verbal output through play-based activities.

A voice disorder occurs when voice quality, pitch, and loudness change/differ or do not fit an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone et al., 2010; Lee et al., 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 2011; Stemple et al., 2010; Verdolini & Ramig, 2001). Specific diagnoses may include:

• Vocal fold paralysis
• Spasmodic dysphonia
• Vocal fatigue
• Muscle tension dysphonia
• Aphonia
• Chronic cough/throat clear
• Paradoxical vocal fold motion disorder (AKA vocal cord dysfunction)
• Vocal tremor
• Vocal nodules

Voice therapy addresses muscle tension, vocal hygiene, vocal use, breathing, and behavioral strategies to assist the client in achieving their desired, healthy voice.

Fluency refers to continuity, smoothness, speed, and effort in talking or producing speech. All speakers are disfluent at times. Everyone may hesitate, rephrase, or use fillers (e.g., “like”, “uh”). These are called typical disfluencies.

A fluency disorder is a change in the flow of speaking due to atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks). In fluency disorders, a person may also experience excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a).

Stuttering is the most common fluency disorder. It is an interruption in the flow of speaking characterized by repetitions, prolongation of sounds, and blocks (getting stuck). Both adults and children may stutter and it may come and go throughout a person’s lifetime.

Cluttering is another fluency disorder that is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). Individuals may have cluttering on its own or cluttering with stuttering (van Zaalen-Op’t Hof et al., 2009).

Fluency therapy focuses on identifying types of disfluencies and providing behavioral, social, and emotional interventions to help the client improve their confidence and relationship with speaking.

Adults may have speech sound disorders that started when they were children. This may include difficulty saying certain sounds or others having difficulty understanding you. Other adults may have speech difficulties after a stroke, brain injury, or as a symptom of a progressive disease (e.g., ALS). Apraxia of speech and dysarthria are two motor speech disorders seen following strokes and brain injuries. 

Apraxia of speech happens when your brain does not communicate with your muscles correctly due to brain damage. This may make it difficult to move your lips or tongue in the right way to make sounds. Sometimes, it might be difficult to speak at all. 

Dysarthria is when brain or nerve damage changes the way your muscles work. It can be mild to severe and can cause difficulties including slurring/mumbling speech, difficulty controlling rate of speech, difficulty controlling breathing when speaking, and more.

Adult speech therapy consists of training/retraining speech sounds through repetition and examples. Therapy starts with production of each sound in isolation and builds toward producing words, sentences, and finally application during conversation.

Aphasia is a language disorder that affects how you communicate. It is caused by damage to the language centers of the brain, usually in the left side of the brain, that control understanding, speaking, using signed languages, reading, and writing. This damage can happen due to stroke, traumatic brain injury, progressive diseases (e.g., primary progressive aphasia), or other causes of brain damage (e.g., hypoxia, respiratory failure, etc.)

Aphasia does not impact how smart you are or cause problems with thinking skills but it may make it difficult to communicate your thoughts easily. Aphasia can affect people in different ways, and no two people will have the same changes or recovery. The severity and recovery of aphasia depend on a number of things—including the cause, the extent of damage to the brain, family support, and treatment.

Aphasia treatment includes retraining impacted language skills through repetition and practice with relevant, functional tasks to support carryover of skills to daily life.

An individual with a cognitive-communication impairment may have difficulty planning, paying attention/concentrating, organization, problem-solving/reasoning, and executive functions. This may be caused by a traumatic brain injury, stroke, progressive diseases (e.g., dementia), or other non-traumatic brain injury. These difficulties may impact an individual’s ability to complete necessary life tasks and may lead to frustration, conflict with loved ones, reduced independence, and more.

Therapy may include supporting development of strategies to improve functional skills and assist the client with returning to daily life activities such as managing medications, paying bills, work tasks, etc.

A voice disorder occurs when voice quality, pitch, and loudness change/differ or do not fit an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone et al., 2010; Lee et al., 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 2011; Stemple et al., 2010; Verdolini & Ramig, 2001). Specific diagnoses may include:

• Vocal fold paralysis
• Spasmodic dysphonia
• Vocal fatigue
• Muscle tension dysphonia
• Aphonia
• Chronic cough/throat clear
• Paradoxical vocal fold motion disorder (AKA vocal cord dysfunction)
• Vocal tremor
• Vocal nodules
• Voice impairment secondary to Parkinson’s disease

Voice therapy addresses muscle tension, vocal hygiene, vocal use, breathing, and behavioral strategies to assist the client in achieving their desired voice.

Dysphagia is a swallowing difficulty impacted by changes to the face, mouth, pharynx, or esophagus. Swallowing impairment may be the result of stroke, brain injury, progressive diseases, or may be related to comorbidities (e.g., esophageal dysmotility). Consequences of dysphagia include malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death. Adults with dysphagia may also experience decreased interest or enjoyment of food, embarrassment, and/or isolation related to eating and drinking. Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and diagnose and manage oral and pharyngeal dysphagia. SLPs also recognize causes and signs/symptoms of esophageal dysphagia and make appropriate referrals for its diagnosis and management. 

Dysphagia therapy often focuses on swallowing exercises, use of compensatory swallowing strategies (including posture considerations), food/liquid consistency modification, and caregiver/patient education.

Fluency refers to continuity, smoothness, speed, and effort in talking or producing speech. All speakers are disfluent at times. Everyone may hesitate, rephrase, or use fillers (e.g., “like”, “uh”). These are called typical disfluencies.

A fluency disorder is a change in the flow of speaking due to atypical rate, rhythm, and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and blocks). In fluency disorders, a person may also experience excessive tension, speaking avoidance, struggle behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA], 1993). People with fluency disorders also frequently experience psychological, emotional, social, and functional impacts as a result of their communication disorder (Tichenor & Yaruss, 2019a).

Stuttering is the most common fluency disorder. It is an interruption in the flow of speaking characterized by repetitions, prolongation of sounds, and blocks (getting stuck). Both adults and children may stutter and it may come and go throughout a person’s lifetime.

Cluttering is another fluency disorder that is characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues, decreased awareness of fluency problems or moments of disfluency, excessive disfluencies, collapsing or omitting syllables, and language formulation issues, which result in breakdowns in speech clarity and/or fluency (St. Louis & Schulte, 2011; van Zaalen-Opt Hof & Reichel, 2014). Individuals may have cluttering on its own or cluttering with stuttering (van Zaalen-Op’t Hof et al., 2009).

Fluency therapy focuses on identifying types of disfluencies and providing behavioral, social, and emotional interventions to help the client improve their confidence and relationship with speaking.

Memory is the process of receiving, encoding, restoring, and retrieving information. The types of memory include working memory, short-term memory, long-term memory, and prospective memory. We need all types of memory to function properly in order for use to recall past and future events. Many diagnoses can impact memory including stroke, brain injury, and progressive diseases (e.g., dementia). Memory may also decline with age, although significant and rapid decline is not part of the typical aging process.

Functional memory therapy includes identifying common problems related to memory difficulties and problem-solving to apply strategies for supported improvement in independence and success in functional daily living tasks. Family training is often indicated as well to further support the client’s success and facilitate application of learned strategies at home.