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Speech sound disorders: classification, assessment and choice of treatment
A speech sound disorder can be phonetic (a motor difficulty producing a particular sound) or phonological (a difficulty in the language's rule system), and the two can occur together; treatment is chosen by type — minimal-pair contrasts for a consistent disorder, core vocabulary for an inconsistent one and motor practice for a phonetic problem.
Why it matters in the exam
Exam questions ask you to choose an approach and a starting point: in the phonological approach you start at word level with minimal pairs; a child with an inconsistent phonological disorder suits the core vocabulary approach; in backing you start by producing the sound in a syllable with sensory and visual cues; and in the first stage of treating fronting of /k, g/ you avoid words such as "tik" (bag), where the front context makes it harder. Choosing a minimal pair is asked too: a child who omits word-final codas — "bo" versus "bots"; a child who omits initial consonants — "alon" versus "xalon" (oak versus window).
Another part concerns definition and prognosis: under DSM-5 a speech sound disorder does not include difficulty in motor planning; the cause of these disorders is unknown in most cases and is usually not motor; being able to improve a sound already during the assessment (stimulability) predicts a good prognosis; reading skill plays no part in picking the first target; specific feedback describes exactly what the child did right; and a participation-level goal describes using the sound in life, such as calling a friend by name during a game. When a child who replaced /s/ with /t/ starts saying "misa" for "mita" (bed), that is overgeneralisation that shows learning.
Key points
- Phonetic = motor, for a particular sound; phonological = the rule system.
- Consistent — minimal pairs; inconsistent — core vocabulary.
- The phonological approach starts at word level.
- Improving during assessment predicts a good prognosis.
- Assess in single words and in connected speech.
Summary table
| Type | Feature | Treatment approach | Starting point |
|---|---|---|---|
| Phonetic (articulation) | A motor difficulty producing a particular sound, consistent | Traditional practice in a hierarchy: sound, syllable, word, sentence, conversation | Production in a syllable with sensory and visual cues |
| Consistent phonological | Regular patterns (processes) across several sounds | Minimal pairs and contrasts | Word level; sometimes auditory discrimination first |
| Inconsistent phonological | The same word comes out differently each time, without motor signs | Core vocabulary | Useful words from the child's life |
| Phonological delay | Processes typical of a younger age | Phonological approach | The processes that harm intelligibility most |
| Prognosis and target choice | Improving during assessment predicts success | Targets by intelligibility, function and age norms | Not by reading ability |
| Assessment | Structured test (picture naming) and connected speech | Each context adds unique information | Also check discrimination and the phoneme inventory |
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Sources
- Dodd, Differential Diagnosis and Treatment of Children with Speech Disorder, 2nd edition (2005) — Subgroups of speech disorder and their treatment
- Williams, McLeod & McCauley (eds.), Interventions for Speech Sound Disorders in Children, 2nd edition (2021) — Minimal pairs, core vocabulary and other approaches
- American Psychiatric Association, DSM-5, 2013 — Speech sound disorder
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.