Regional, social, and cultural considerations should be made before making a speech sound diagnosis. Bilingual children may demonstrate an overall lower intelligibility rating, make more overall consonant and vowel errors, and produce more error patterns than solely English-speaking children.

Normal Variations in Speech as a Differential Diagnosis to Speech Sound Disorder

Those who are deaf or hard of hearing may have speech sound production errors. A speech sound diagnosis may be made when deficits are in excess of those typically associated with these conditions.

Hearing or Other Sensory Impairment as a Differential Diagnosis to Speech Sound Disorder

Impairment in speech may be caused by a structural deficit present at birth, such as cleft palate.

Structural Deficits as a Differential Diagnosis to Speech Sound Disorder

Speech impairment and errors in speech sound production can be attributable to a motor disorder such as cerebral palsy. Neurological signs and distinctive features in voice differentiate these from speech sound disorder, but differentiation may be difficult before 3 years of age when there is minimal or no general body motor involvement.

Dysarthria as a Differential Diagnosis to Speech Sound Disorder

Limited speech can be a sign of selective mutism, an anxiety disorder characterized by lack of speech across settings. Selective mutism may develop among children with speech sound disorder due to embarrassment about their errors or impairment, but many children with selective mutism exhibit normal speech in settings they deem "safe."

Selective Mutism as a Differential Diagnosis to Speech Sound Disorder

Speech Sound Disorder may have features that overlap with other speech patterns, conditions, or disorders, including:

- Normal variations in speech

- Hearing or other sensory impairment

- Structural deficits

- Dysarthria

- Selective mutism

Cleveland State University

"Speech sound disorders" (SSD) is an umbrella term which refers to any communication disorder defined by persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages. 

The condition is marked by developmentally inappropriate errors in speech production, due to impairments in articulation and phonological processing which arise from a variety of limitations related to perception, speech motor, and/or linguistic processes. 

SSD can be subdivided into two primary groups: 1) articulation disorders (also known as phonetic disorders) and 2) phonological disorders. 

Speech Sound Disorder (SSD)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

A. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages.

B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination.

C. Onset of symptoms is in the early developmental period.

D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions.

DSM-5-TR Diagnostic Criteria of Speech Sound Disorder

Associated features of Speech Sound Disorder include:

- Co-occurrence with language disorder
- Family history of speech or language disorders
- History of delay or incoordination in acquiring skills that also utilize the articulators and related facial musculature; including chewing, maintaining mouth closure, and blowing the nose
- Impaired motor coordination in other areas

Associated Features of Speech Sound Disorder

- Articulation of speech sounds follows a typical developmental
pattern, reflected in standard age norms. Mostly intelligible speech should be heard by 3 years of age. Children with speech sound disorder continue to use immature phonological simplification processes past the age most children can pronounce words clearly.

-  The most frequently mispronounced sounds in English also tend to be learned later, (l, r, s, z, th, ch, dzh, and zh). Misarticulation of any of these sounds by itself could be considered within normal limits up to age 8 years of age; however, when multiple sounds are involved, it is important to target some of those sounds as part of a plan to improve
intelligibility.

- Most children with speech sound disorder respond well to treatment and the disorder may not be lifelong. However when a language disorder's present prognosis is poorer it may be associated with a learning disorder.

Development and Course of Speech Sound Disorder

Differential Diagnosis to Speech Sound Disorder

Speech may be impaired in certain genetic conditions, such as:

-Down Syndrome

-22q deletion

-FoxP2 gene mutation.

Comorbid Diagnoses to Speech Sound Disorder

This includes the intersection of connections and/or research related to Speech Sound Disorder as a general category in other fields of study and research. Such fields include:

-TBD


Interdisciplinary Connections & Research Related to Speech Sound Disorder

American Speech-Language-Hearing Association. (n.d.). Speech Sound Disorders: Articulation and Phonology. American Speech-Language-Hearing Association. Retrieved May 31, 2023, from https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/#collapse_9

The "Speech Sound Disorder (SSD)" concept node included paraphrased information from this source regarding the categorization of SSD into two groups: 1) Articulation Disorders and 2) Phonological Disorders. 

American Speech-Language-Hearing Association, n.d.

Namasivayam, A. K., Coleman, D., O’Dwyer, A., & van Lieshout, P. (2020). Speech Sound Disorders in Children: An Articulatory Phonology Perspective. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.02998

The "Speech Sound Disorder (SSD)" concept node included paraphrased information form this source regarding the definition of SSD, specifically on the developmental errors arising from perception, speech motor issues, and/or linguistic impairments which contribute to SSD. 

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