All About Articulation Disorders

Do you have questions about articulation disorders?

Perhaps you’re wondering:

What are the 4 types of articulation disorders? 

Articulation disorder vs. phonological disorder—what’s the difference? 

It’s critical for speech-language pathologists (SLPs) to know the answers to these questions in order to make accurate diagnoses and support clients in meeting their treatment goals. 

SLPs commonly treat clients with speech sound disorders—such as articulation disorders—alongside a wide variety of other speech, language, voice, and fluency conditions.

While the scope of the profession of speech-language pathology is far-reaching, articulation is usually what we think of first when we think about “speech.” 

Treating articulation and phonological disorders is familiar territory for SLPs who work with children. 

That said, differentiating between speech sound disorders and identifying appropriate articulation assessment methods can prove to be difficult.

As an SLP, we often need to balance significant paperwork with a complex caseload, which can be challenging and time-consuming. A solid understanding of articulation disorders, combined with articulation assessment results can enable you to make impactful treatment decisions and help you to spend your time more efficiently.    

Articulation disorder versus phonological disorder

Even among highly trained SLPs, differentiating between an articulation disorder and a phonological disorder can feel confusing. And, further complicating things, many SLPs use the umbrella term “speech sound disorders” to describe both. 

At face value, articulation disorders and phonological disorders have a number of symptoms in common. However, when we dig deeper, we can spot some key differences. 

In short, an articulation disorder is motor based, while a phonological disorder is linguistic in nature. 

It’s possible for clients to present with both disorders at the same time, and this is  why the topic can be a source of confusion among clinicians and parents alike. 

Also known as articulation delay, articulation disorder involves difficulty with the motor functions that underlie speech sound production. 

Children who present with a delay, may struggle to coordinate articulators like the tongue, lips, teeth, and palate to form certain phonemes. This can lead to substitutions, distortions, omissions, or additions of other phonemes in place of the target sound. 

By contrast, a phonological disorder is linguistically oriented and involves predictable, rule-based errors called phonological processes. These error patterns affect more than one sound. 

Furthermore, clients with phonological processes can physically make the sound, but habitually follow incorrect linguistic patterns to simplify their speech. 

Some phonological processes are typical of early speech development, but should be outgrown at a certain point. For example, this includes the process known as “gliding,” which is when clients substitute the sound of “w” for “r” in a word like “rabbit.” In this example, the client can sound out the letter “r” separately, but habitually substitutes the “r” with a “w” in their speech. 

This is different from articulation speech patterns, wherein the client is experiencing motor function issues that prevent them from making the “r” sound. 

Other phonological processes are not heard in typically developing speech, for example, swapping a “d” for a “g,” also known as “backing.” 

Articulation disorder and phonological disorder share an ICD-10 code

Adding to the confusion, the phonological and articulation disorder ICD-10 codes are the same. ICD-10 codes are used for diagnosis and insurance billing. 

This means, we use ICD-10 code F80.0 for clients diagnosed with either disorder, without underlying medical conditions.

ICD-10 code F80.0 specifically denotes individuals with articulation or phonological delays that do not stem from a separate condition. 

Speech impairments due to childhood apraxia, hearing loss, or intellectual disability belong in a separate category with other diagnoses. 

4 types of articulation disorders

Speech sound disorders follow predictable patterns. They involve clear, consistent differences in speech production, which can make words unintelligible. 

An articulation disorder impedes communication, and this can cause frustration for the speaker and their communication partners. 

Before SLPs can provide therapy, we must identify the type of articulation issues we are addressing. 

Articulation assessments are essential for screening clients who present with symptoms of articulation delays.

There are four clear articulation error patterns SLPs are likely to see. 

These are not the same as phonological processes and—in isolation—are indicative of an articulation disorder, or delay, rather than a phonological disorder. 

1. Substitution:

   This occurs when a client replaces one speech sound with another, because they are unable to make the correct sound to properly pronounce the word. For example, a client who has a hard time sounding out the letter “r,” might substitute “w” in place of “r,” as in “wabbit” for “rabbit.”

2. Distortion:

   This is when clients alter a sound without directly substituting it for another phoneme. For example, a client who cannot sound out the letter “l” may pronounce the word “telephone” without the “l,” as “tephone.” This speech error can reduce intelligibility. 

3. Addition:

   This involves adding sounds or syllables to words where they don’t belong. For example, “suh-leep” instead of “sleep.”

4. Omission:

   Like it sounds, omission means deleting particular phonemes or phoneme combinations from words. Examples of omission speech errors include  saying “cool” instead of “school” or “rake” instead of “brake”.

Keep in mind that as young children learn to communicate, it’s natural for them to present with one, or even several, of the four types of articulation error patterns described here. 

For example, a three-year-old who pronounces “rabbit” as “wabbit” is displaying age-appropriate speech sound development, since the phoneme “r” may not be acquired until age six or later, in some cases. However, a seven-year-old who presents with this same error pattern may have an articulation delay or disorder. 

As an SLP, it’s essential to be familiar with the norms for speech sound development and articulation assessment measures, so you can identify an articulation disorder and differentiate it from typical patterns of speech sound acquisition. 

According to the American Speech-Language-Hearing Association (ASHA), three-year-olds should be able to say the m, n, h, w, p, b, t, d, k, g, and f sounds in words. By age four, children should be able to make the y and v sounds, though they may still make mistakes on s, sh, ch, j, ng, th, z, l, and r when they speak. 

If a child continues to present with substitutions, distortions, additions, or omissions on specific phonemes beyond a developmentally appropriate age, an articulation issue may be the root cause. 

Some speech therapists use the term articulation delay interchangeably with articulation disorder. 

Is there a difference? 

It depends on who you ask. 

An articulation disorder may be viewed as more severe or requiring more intensive intervention than a delay. A client who presents with unusual patterns of substitution, distortions, additions, or omissions that are not reflective of typical speech sound development may exhibit a disorder rather than a delay. 

Speech therapy assessments are helpful in distinguishing between articulation delays and disorders–and in separating them from phonological ones. 

Speech therapy assessments

To accurately diagnose, it’s important to conduct a comprehensive speech and language assessment. 

A complete evaluation by a speech-language pathologist will include an articulation assessment in tandem with other speech and language measures. 

There are numerous speech therapy assessment tools available to SLPs, who may be seeking differential diagnoses for clients who present symptoms for articulation or phonological delays. 

Assessment typically involves using formal and informal assessment tools alongside standardized and unstandardized measures. Oral-motor functioning may be examined, and written and spoken language may be assessed within the scope of a full evaluation. 

SLPs also need to consider each client’s cultural-linguistic background to ensure the assessment takes into account variations in dialect, accent, and phonemic production across diverse communities. Additionally, it’s critical to gather case history information from the client’s caregiver, if applicable. 

In the context of a comprehensive evaluation, some common standardized phonology and articulation assessments include:

• The Goldman-Fristoe Test of Articulation, Third Edition
• The Clinical Assessment of Articulation and Phonology, Second Edition
• The Arizona Articulation Proficiency Scale, Fourth Edition

Speech therapists should also obtain a standardized measure of expressive and receptive language. 

A list of speech and language assessments designed to test these skills includes:

• The Preschool Language Scale, Fifth Edition (for children up to age seven)
• Clinical Evaluation of Language Fundamentals, Fifth Edition 
• Oral-Written Language Scale, Second Edition

Identifying the root cause of a speech sound disorder is essential for SLPs who want to deliver the most effective treatment as early as possible. 

Giving clients the tools to communicate with greater ease is what makes our profession so fulfilling.

When speech therapists can confidently differentiate articulation from phonological disorders, they can help children build the skills to express themselves and connect with others sooner. 

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