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.

Cleveland State University

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

Differential Diagnosis to Speech Sound Disorder

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

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."

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