Articulation Disorder: Causes, Symptoms & Treatment

The term articulation disorder refers to various problems in a person’s individual sound formation that deviate from the standard. This means that certain sounds are either not formed at all or are formed incorrectly. The causes of an articulation disorder can be very diverse, and treatment is usually provided by a speech therapist.

What are articulation disorders?

The medical term for an articulation disorder is dyslalia. In this type of speech disorder, individual or connected sounds (such as the sound sequence “sh”) are pronounced incorrectly, put together incorrectly or omitted completely when speaking. These errors occur particularly frequently with the so-called sibilants. This mispronunciation of the letters and sound sequences “s”, “z”, “ch” and “sch” is known in colloquial language as lisping. Articulation disorders occur particularly frequently in childhood. During the phase of language acquisition, almost fourteen percent of children between the ages of four and six have disorders of this type. Dyslalia can generally be divided into two groups, but can also occur as a hybrid of the two. On the one hand, there are phonological disorders in which individual sounds can be pronounced correctly, but the affected person is unable to do so in the flow of speech. For example, a person may be able to pronounce the letter “s” correctly, but still have a lisp when speaking. On the other hand, there are phonological disorders in which sounds and sound sequences generally cannot be pronounced correctly, even in isolation. Here, for example, it is generally not possible for the affected person to pronounce the letter “s” correctly.

Causes

There are many causes of an articulation disorder. First of all, congenital or acquired malformations of the organs of articulation (lips, tongue, palate, jaw) can lead to the symptoms. Such malformations make correct articulation difficult. Hearing disorders can also lead to dyslalia. The affected persons do not hear their own faulty pronunciation and thus articulation disorders can occur. In the case of a myofunctional disorder, the muscle tension in the area of the mouth is impaired. This disturbance of the muscle tension leads to a faulty pronunciation of sounds or sound sequences. In most articulation disorders, however, there is no underlying organic cause at all. Rather, the problem lies in bad habits. For example, children may have the wrong speech models, which causes them to get into the habit of not pronouncing sounds and sound sequences correctly. Or the implementation of the correct sounds is not practiced closely enough. Once a person gets used to this incorrect pronunciation, an articulation disorder is also present. The longer children retain and thus automate the incorrect pronunciation, the more difficult it becomes to treat.

Symptoms, complaints and signs

An articulation disorder can lead to a number of different symptoms and complaints and generally significantly limits the patient’s quality of life. In this case, most affected individuals are unable to pronounce various sounds or letters correctly. This leads to a speech disorder, so that communication with other people is also disturbed. Particularly in childhood, this can lead to bullying or teasing and thus also to psychological complaints and upsets. The complete omission of sounds and letters can also occur due to the articulation disorder. This significantly limits and delays the child’s development. If the articulation disorder is not treated, it can lead to complications or speech problems even in adulthood. Many patients also suffer from lisping. In the case of malformations or deformities in the oral cavity, these can also lead to swallowing difficulties in some cases, making it much more difficult to take in food and liquids. Stroke can also cause the articulation disorder and usually occurs with other complaints. Often, the parents or relatives of the affected child also suffer from psychological discomfort and depression due to the articulation disorder and therefore also require psychological treatment.

Diagnosis and course

The diagnosis of articulation disorders in childhood is mostly made from the environment. Parents, friends, teachers or educators initially simply notice the incorrect pronunciation.Then either the pediatrician or a speech therapist consulted will decide whether the abnormality is only temporary or requires treatment, i.e. whether it is actually an articulation disorder. Speech therapists have special and reliable test procedures that provide information. The course of the disorder depends on its causes on the one hand and on its (early) treatment on the other.

Complications

Articulation disorders can arise due to various causes and, accordingly, have various complications. First, congenital malformations can cause articulation disorders. These include, for example, cleft lip and palate (cheilopalatognathoschisis). Due to this condition, the affected individuals often have to go to the hospital and undergo treatments, which is a psychological problem. In addition, the children are often ridiculed because of their appearance and pronunciation, which increases the psychological problem. This leads to social isolation at a very early age, which can develop into depression in adulthood, characterized by alcohol and drug behavior. It is also not uncommon for those affected to contemplate suicide. In addition, a cleft lip and palate causes a problem with food intake. Simultaneous breathing while drinking is no longer possible. A stroke also often leads to problems with articulation. In addition to difficulties with pronunciation, affected persons also have problems understanding what is being said. It is not uncommon for paralysis to occur. Affected persons usually cannot move their legs or arms and are paralyzed on one side. Bladder or fecal incontinence can often also occur, leaving patients in need of care in most cases. Mental performance is also impaired, and patients often become demented and suffer from amnesia. In addition, personality may change. In the worst cases, a stroke leads to failures in vital processes, so that this results in death.

When should you go to the doctor?

As a rule, an articulation disorder should be examined and eventually treated by a doctor as early as possible. In doing so, complications in adulthood can be avoided. Likewise, especially in children, teasing and bullying are thus avoided. A doctor should be consulted if the child is unable to express himself or herself correctly or if an articulation disorder occurs suddenly and without any particular reason. The causes of articulation disorder can be very different. In many cases, those affected suffer from psychological complaints, but physical limitations can also lead to an articulation disorder. Especially after a stroke, it is not uncommon for articulation disorders to occur. Unfortunately, these cannot always be treated, so that in many cases those affected are dependent on the help of other people. In order to guarantee a complication-free development of the child, a doctor should be consulted at the first signs of an articulation disorder. As a rule, this can involve a direct visit to a pediatrician or speech therapist, who can initiate appropriate treatment for the articulation disorder.

Treatment and therapy

Treatment for articulation disorders is usually provided by a speech therapist. They tailor their treatment plan according to the patient and their speech problems. The first thing to do is to become aware of the problem. The patient should first become aware that his pronunciation of sounds or sound sequences deviates from the standard. The treatment of articulation disorders is usually carried out by a speech therapist. They create their treatment plan individually according to the patient and his speech problems. The first step is to become aware of the problem. The patient should first become aware that his pronunciation of sounds or sound sequences deviates from the standard. The correct pronunciation is then gradually trained using various exercises and methods. These include breathing exercises, word formation exercises based on individual letters and syllables, listening exercises and much more. This type of training is done in a playful way with children. The level of difficulty is gradually increased so that, for example, incorrect automatisms are slowly corrected. The goal is always to improve pronunciation in the direction of the norm.If the cause of an articulation disorder is a problem with hearing, an ear, nose and throat specialist should also be consulted, who will look into the physical causes of the problem. However, even in this case, logopedic treatment may be useful. In the case of deformities in the area of the speech tools, various procedures can be useful. In the case of a so-called cleft palate, for example, even a surgical intervention may be necessary for improvement. However, malformations can also be used by logopedic intervention for articulation disorders, as they show other ways to use the affected regions of the speech tools.

Outlook and prognosis

Early diagnosis of an articulation disorder ensures a good chance of recovery for the child. The sooner a speech therapist can develop an individualized treatment plan, the sooner therapy can begin. Since the learning success of the speech center is generally greater the younger the child is, the possibility of learning to form sounds without accent or discomfort gradually decreases over the first years of life. The differentiation of new sounds is trained in a therapy process. This is the basis for correct phonation. If the individual sounds can be perceived well separated from each other, the probability increases that they can be correctly reproduced. Various breathing and word techniques are used to train the phonation until the disorder has been completely eliminated. If there is a physical cause for the articulation disorder, correction can be achieved in a surgical procedure. Here, too, the prospects of recovery are very good. The prognosis for freedom from symptoms changes if the cause is a mental illness or psychological suffering. In psychotherapy, the reasons for the articulation disorder must first be clarified and remedied so that the phonation can improve. The duration of a mental healing process is individual and can last several months to years. Often, logopedic treatment is only promising afterwards.

Prevention

It is not possible to prevent the physical causes of articulation disorders. Prevention is only possible for disorders that do not have a physical cause. Children should have good speech role models who value correct pronunciation of sounds. If a child develops problems in articulation, the caregivers should intervene in a corrective way so that this behavior does not become automatic. If the incorrect behavior does not improve on its own, the pediatrician or a speech therapist should be consulted.

Follow-up

Whether follow-up care is necessary at all for an articulation disorder that has been treated depends on the individual case. In general, forms of dyslalia treated in childhood have an excellent prognosis and the therapies are considered effective. Relapses are rare, but possible. This often depends on personal circumstances and especially on possible psychological stress. In the broadest sense, aftercare would therefore consist of occasional further visits to therapy services. Self-help groups can also be relevant if the speech disorder is not overcome despite therapy. Outside of therapy, self-control exercises are also suggested, which those affected can continue to do after therapy to keep their dyslalia under constant self-control. Control examinations are usually not necessary, since a flare-up of articulation disorder can be noticed by the affected person himself and by his environment. None of the therapeutic and logopedic measures involve medication, so accordingly, no follow-up care is required. It is worth mentioning that under certain circumstances there may be increased psychological stress due to an articulation disorder. This is mostly due to the reactions of the environment as well as own insecurity. In such cases, aftercare measures may be necessary following therapy for the articulation disorder in order to rebuild and strengthen missing self-confidence.

What you can do yourself

If children have difficulty articulating certain sounds and sound combinations, a few simple speech-enhancing aids from parents can be very useful. Speaking begins at home, and so parents, with their linguistic role models, have the best opportunity to help their child learn to speak.It is important to let the child speak, to listen to him calmly, to look at him while he is speaking and not to improve the pronunciation while he is talking. Parents repeat complicated sentences with simple, child-friendly words and correct them in this way. Attention should be paid to correct grammar. However, the child should not be forced to repeat afterward. Singing, dancing, looking at picture books, rhyming, telling little verses and stories form the basis for good speech development. Calm, emphasized and slow speech by the parents is conducive to this. For some children, it helps to illustrate the difference in meaning that can result from some sound interchanges. It makes a difference whether the soup is boiling in the “pot or in the head” or whether one is holding a “bench or a ribbon” in one’s hand. Many children understand through these so-called minimal pairs how important it is to listen and speak carefully. If in doubt, a consultation with a speech therapist may be useful.