Speech & Hearing - Speech Sounds

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Speech is a fine motor activity to produce sounds involving the coordination of the lips, tongue, vocal folds, the vocal tract, and respiration. These sounds form the basis of words that are used for the purpose of communication. There is a developmental sequence of sounds. Some sounds are produced earlier than others. For example, children usually say "p, b, m, f, t, d" before "s, th, r." As children develop, they acquire the ability to produce more and more sounds and sound combinations (e.g., blue, flight) clearly.

While learning to speak, all children pronounce some words incorrectly. You may hear a child substitute one sound for another (wabbit for rabbit), or omit a sound (do for dog) or distort a sound (shlip for ship). Although these are common speech errors and will probably disappear as a child gets older, they might also be signs of an articulation disorder. Simply stated, an articulation disorder exists when a child consistently makes speech sound errors that are not usually made by children of the same age.

Your child may have an articulation disorder if sounds are not progressing according to the following developmental sequence.

Birth-3 Months

  • makes pleasure sounds
  • cries differently for different needs
  • smiles when seeing you

4-6 Months

  • babbling sounds more speech-like with many different sounds, including p, b, m
  • vocalizes excitement and displeasure
  • makes gurgling sounds when left alone and when playing with you

7 Months-1 Year

  • babbling has both long and short groups of sounds (tata, upup, bibibibi)
  • uses speech or non-crying sounds to get and keep attention
  • imitates different speech sounds
  • has 1 or 2 words (bye-bye, dada, mama) although they may not be clear

1-2 Years

  • about 50% of speech can be understood by a stranger by age 2
  • about 12 consonants account for 95% of the child's utterances (p, t, k, b, d, g, m, n, w, j, h)
  • uses consonant sounds mostly at the beginning of words

2-3 Years

  • about 75% of speech can be understood by a stranger by age 3
  • most children can say sounds at the beginning, middle, and ends of words
  • can pronounce consonant blends (st, pr) at the beginnings and ends of words

3-4 Years

  • about 90% of speech can be understood by a stranger by age 4
  • may still have trouble with longer words (spaghetti, aluminum)

4-5 Years

  • sounds are clear like other children's
  • says most sounds correctly except a few like l and r

Verbal apraxia in children (or childhood apraxia of speech) is defined as the inability or difficulty with purposeful voluntary movement for speech. Children with verbal apraxia will have difficulty positioning and sequencing movements of muscles specifically for speech.

Oral apraxia involves difficulty with specific volitional production of nonspeech movement of the articulators (blowing, puffing out cheeks, coughing, lip smacking). Children with oral apraxia will have difficulty imitating such movements or producing them on command.

Characteristics of Verbal Apraxia:

  • Difficulty initiating speech movements
  • Difficulty putting sounds in the correct order
  • Struggling-groping behaviors during speech
  • Omission of sounds
  • More difficulty with longer words and sentences
  • Atypical intonation
  • Vowel distortions
  • Slow rate of speech
  • User of fewer sounds in speech
  • Inconsistent mistakes (the child can produce the sound sometimes but not others)
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Education Links

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» ENT Problems
» Speech & Hearing
» Common Surgeries
» Post-Op Instructions


Clinic Locations

Ear, Nose & Throat Clinic
University Hospital Clinics Building
1005 Harborside Drive
Galveston, Texas

Ear, Nose & Throat Consultants
Brittany Plaza
1600 West League City Parkway, Suite D
League City, Texas

Family HealthCare Center
Mainland Crossing
9300 Emmett F. Lowry Expressway
Texas City, Texas

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