Phonological disorder Health Article

Diagnosis

The diagnosis for phonologic disorder depends greatly on the age of the child in question. Children who are four years old may have speech production difficulties that show normal development for their age, while children who are eight years old and making the same mistakes may have phonological disorder. In children with phonological disorder, the pattern and order of speech sound acquisition is usually similar to that of normally developing children. However, the speech sound skills develop more slowly, so age is an important factor in determining a diagnosis of phonological disorder. Children with phonological disorder may make the same speech sound mistakes as younger, normally developing children. In some cases, however, children with phonological disorder have demonstrated more instances of omissions, substitutions, and distortions in their speech.

When exploring a diagnosis of phonological disorder, it is generally recommended that a physician check for other possible causes of the signs and symptoms. A child's hearing should be checked, because speech sounds that are not heard well by a child cannot be imitated and learned well. In school-age children, reading comprehension should be checked to discover any other language disorders, which are sometimes present in addition to phonological disorder. Any general developmental delays should also be checked by the physician. It is important to remember that for some children whose native language is one other than English, the problems with speech sounds may result from poor crossover of sounds between the child's languages. Therefore, when diagnosing a child with a different native language, it is recommended that tests involve the child's first language, as well as English. Also, it must be remembered that in some parts of the country, normal pronunciation of some words is different from pronunciation in other parts of the country. Therefore a child's background and history can be very important in making a diagnosis.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) states that for a diagnosis of phonological disorder to be made, three general criteria must be met. The first criterion is that the child is not developing speech sounds skills considered to be appropriate for his or her age group. Also, this lack of speech sound acquisition must be causing problems for the child at home, at school, or in other important aspects of the child's life. If the child is mentally retarded, has problems with his or her speech muscles or hearing, or if there is environmental deprivation, a diagnosis of phonological disorder may still be appropriate. The diagnosis can only be made, however, if the lack of speech sounds skill is considered greater than the child's other problems.

Demographics

Phonological disorder of unknown cause is considered significantly more common than phonological disorder that is caused by neurological or structural abnormalities. It has been estimated that 7–8% children who are five years old have phonological disorder with any cause (developmental phonological disorder). About 7.5% of children between the ages of three and eleven are thought to have development phonological disorder. Phonological disorder is more common in boys than it is in girls. Estimates suggest that two to four times as many boys as girls have the disorder. Children who have phonological disorder are more likely to have other language problems and disorders. Children with one or more family members who have this or similar language disorders are also considered to be more likely to have phonological disorders.

Treatment

Treatment by a speech-language pathologist is generally recommended for children with phonological disorders. The therapy will differ depending on an individual child's needs, but generally takes the form of practicing sounds. Sometimes the child is shown the physical ways that the sound is made, such as where to place the tongue and how to form the lips. Repetition of the difficult sounds with the therapist is an integral part of treatment. There is debate, however, over the way that children with more severe forms of the disorder should be treated. Some therapists believe that the sounds that are learned later in development should be addressed first, even if the child has not developed the more simple sound skills. Other therapists believe that simple sounds should be treated first, as it is easier for children with phonological disorder to master them. One other school of thought is that when the child develops a sense of accomplishment when these sounds are mastered, and he or she will more willingly continue with treatment. There is ongoing research on this debate, and the results as of 2002 are still mixed.

Children who have phonological disorder because of neurological or structural problems that do not allow them to produce some sounds are often helped to find approximate alternatives for the sounds within the range of sounds that they are able to produce.