Phonological Disorders Demystified

Aug 1

Dad practicing speech therapy at home to grow his daughter's phonological skills while coloring on a chalkboard

What is a phonological disorder?

A phonological disorder, sometimes called a phonological process disorder, happens when a child has a hard time learning to pronounce certain sound patterns needed to say words clearly. When a child has a phonological disorder you’ll notice rule based errors that usually affect an entire category of sounds.

It’s important to know that the presence of phonological processes, or simplified sound patterns, doesn’t mean that a child has a phonological disorder because these speech shortcuts are an expected part of development. It’s only when phonological processes persist past a certain age that they are classified as a “disorder” and a child would qualify for speech therapy to learn to pronounce difficult speech patterns.

See our phonological processes chart with ages here.

And no one likes the word “disorder;” the word alone sends your blood pressure through the roof and puts your stomach in knots. If you haven’t yet read our spiel about the word “disorder,” I highly recommend it! You’ll see why speech therapists use the word “disorder” and why it’s not as bad as you’re probably thinking. Read here.

Now that we’ve defined phonological disorder, I think it’s important to talk about the differences between some speech vocabulary terms that sound very similar but mean different things.

Speech Therapy Vocabulary

A phoneme is an individual speech sound; they are all the individual sounds that make up words. For example the word “dog” has 3 phonemes: “d” “o” and “g.”
Phonology is the study of sound patterns and their meanings; it’s all about how we combine different sounds (phonemes) to form meaningful words.
Also referred to as phonological patterns, these are patterns children use to simplify their speech when they are trying to say words that are too advanced for their speech system.

A phonological disorder is present when children face difficulties learning to pronounce certain sound (phoneme) patterns to say words clearly. You will notice rule based errors that usually affect more than one sound.
Phonological awareness is all about a child’s ability to detect and manipulate sounds (phonemes) and syllables in words. Phonological awareness can be broken into 4 primary skills:
Rhyming - can identify words that
Syllable Awareness - knowing how many syllables a word has
Phoneme Isolation - breaking a word up into sounds, knowing if a sound is at the beginning, middle, or end of a word
Sound Blending - putting 2 or more sounds together into a word. For example, if you said the sounds “C A T” and asked “What animal is that?”
The terms phonological processing, phonemic awareness, phoneme awareness, phonological sensitivity, and phonetic awareness are all used interchangeably with phonological awareness.[2]
Phonics is a way of teaching people to read by correlating sounds with letters or groups of letters.

In this post, we’ll be talking primarily about phonological disorders.

How do speech therapists detect a phonological disorder?

Phonological disorders are diagnosed by a speech language pathologist (aka speech therapist) during a speech and language evaluation.

4 year old girl mixing cake batter and smiling in her kitchen at home

You might now be wondering, What’s the difference between an articulation disorder and a phonological disorder? I’ve heard about articulation but phonology is new to me.

Distinguishing between articulation disorders and phonological disorders is the job of a speech therapist during your child’s evaluation. A speech therapist will also want to identify or rule out childhood apraxia of speech. Identifying the correct cause of a child’s speech difficulties is important because each is treated differently. Using articulation therapy strategies will not likely be effective in treating phonological disorders or apraxia, and vice versa.

In order to rule out or diagnose a speech disorder, your child’s speech therapist will use many different tools. The most valuable tool a speech therapist has in identifying speech disorders is their trained ear. After listening to hundreds to thousands of your children talk, we can easily identify patterns in speech characteristic of different speech sound disorders. Speech therapists will also use standardized tests which generate a score; these scores are primarily used to qualify for speech therapy through insurance and in no way reflect how smart your child is. In addition to looking at speech patterns, speech therapists should look at how the phonological disorder is impacting a child’s social life. Are they refraining from talking to others? Are they socially anxious or self conscious? It’s important to consider all aspects of a child’s communication when creating a plan for speech therapy.

At the end of a speech and language evaluation the speech therapist will either diagnose or rule out a phonological disorder (or other speech sound disorder). And if a speech disorder was identified, the speech therapist will create a treatment plan to address a child’s individual needs.

4 year old girl playing pretend kitchen with her dad while her baby brother lays on the floor playing nearby

Articulation vs. Phonological Disorder

It’s not always easy to tell the difference! There are a few ways that articulation disorders and phonological disorders are the same.

Both have to do with the speech sounds kids are making rather than vocabulary knowledge.
“Errors” in articulation and phonological processes are expected at some ages; whereas the same “errors” would warrant support at older ages.

But there are some very important differences between the two.

An articulation disorder occurs when a child has a hard time pronouncing one or a few consonant sounds. For example, they haven’t learned to pronounce the CH sound yet but most other kids their age have.

A phonological disorder happens when children face difficulties learning to pronounce certain sound patterns to say words clearly; you will notice rule based errors that usually affect more than one sound. Just like there are many different sounds in English, there are many different sound patterns. A phonological disorder may be related to one or more of those patterns. Here are a few examples.

One of the most common examples of a phonological disorder is when children over the age of 3 leave consonant sounds off the end of words.
Another example would be a 4 year old always replacing the K sound with T and the G sound with D. This is called fronting because the child’s tongue is touching in the front of the mouth when it should touch in the back of the mouth.
Syllable deletion is another phonological disorder. It’s when kids leave an entire syllable out, like e-phant for elephant, or buh-fly for butterfly, after they are 4 years old.

Phonological Disorder vs Apraxia

The biggest difference between a phonological disorder and apraxia is that the speech errors in phonological disorders follow a pattern whereas the speech errors in a person with apraxia usually do not.

A 4 year old girl and her mom practiced speech therapy at home while baking pop-overs and the little girl is proudly showing them off

Apraxia of speech occurs when a child has difficulty planning and coordinating the movements of their mouth for speech. Children with apraxia are likely to have trouble with lots of different unrelated sounds, including vowels; whereas children with phonological disorders will have trouble pronouncing a certain category of sounds, like consonant sounds made in the back of your mouth (K, G).

If your child is hard to understand it may be hard to know if their errors follow a pattern or not. Speech therapists’ trained ears are accustomed to identifying these differences, which is one of many reasons why seeking a speech and language evaluation if you have concerns is paramount.

You can’t diagnose a phonological disorder at home, but we’ve created a simple and informative “Word Shape” test you can use to take a closer look at your child’s phonological development.

Download the Free Word Shape Test here ↓

The purpose of the Word Shape Test is to help you understand which word shapes your child is able to pronounce and which shapes they're still learning.

This is important for a few reasons.

As children build their repertoire of word shapes, other people can understand them more easily. We want to help you help your child sound more clear and therefore, communicate better with others.
Because phonological processes are a natural part of speech development, it can be too difficult to determine whether your child is progressing on a typical schedule. We want to identify what word shapes they can and can't make and how they compare to most children their age.
Finally, it's possible that your child's phonological development may require help from a speech therapist.

The Word Shape Test will give you more information about your child's phonological development, so you can make the best choice for supporting them. If this is the case, be sure to share this profile with your child's speech therapist.

When you're done, take a look at the sound patterns your child is and isn't using. I recommend a speech and language evaluation if you're concerned about your child's phonological development or if you notice any of the following.

If your child seems to be using many different phonological processes to simplify their words.
If initial or final consonant deletion persists beyond 3 years old.
If your child's speech seems to be so confusing that you can't see any clear patterns.

How do phonological disorders get treated?

Phonological disorders are treated in ongoing weekly or biweekly speech therapy sessions. Treatment almost always begins after children are at least 3 years old.

4 year old girl taking a break from speech therapy for phonological disorder by coloring on chalkboard

If you’re in the United States, children can either access speech therapy through the public school district (available to all children 3+) or through their insurance company at a speech therapy clinic.

Speech therapists will carefully choose which sound patterns to work on and in which order to create a treatment plan.

One of the most researched treatment approaches for phonological disorders is called the complexity model. According to the research, working on sound patterns with later developing speech sounds seems to result in greater improvements in all sounds [1].

How long does speech therapy take?

The amount of speech therapy required to treat phonological disorders will vary greatly. If your child is starting in speech therapy for a phonological disorder you can expect that they will have weekly or biweekly speech therapy sessions for at least a few months.

As with everything else in the realm of communication there’s usually not a quick and easy fix (although I wish there was!). The communication system is far too complex for an overnight solution and we want to be sure we support your child for long term success. Just like training for a marathon, training your speech system will take some time but it pays dividends in the end.

Let’s Review What We’ve Learned About Phonological Disorders:

4 year old girl with phonological disorder playing with her family outside at the park

Phonological disorders are characterized by errors in speech patterns and the same error can be observed for a whole category of sounds. For example, a 4 year old child always leaves the consonant sounds off the ends of words.
Phonological process disorders happen when phonological patterns (patterns for simplified word pronunciation) persist past a certain age.
You can use the Word Shape Test to take a closer look at your child’s speech patterns at home
Speech therapists are experts at identifying the presence or absence of a phonological disorder, articulation disorder, and apraxia of speech.
Treatment for phonological disorders may take place at a public school for children 3+ or at a speech therapy clinic.

Parents also asked:

The causes of a phonological disorder are mostly unknown.
Researchers have found that phonological disorders are more common in boys. They also appear to be more common in children who have a family history of speech and language disorders, hearing loss, general developmental delays, certain genetic diseases, and certain neurological disorders.
Phonological disorders are generally diagnosed after a child is at least 3 years old.
Phonological disorders are less common than articulation disorders. If you look at the research it’s hard to tell the true incidence of phonological disorders because reports vary quite a bit.
If you have concerns of a phonological disorder I recommend scheduling a speech and language evaluation. Regardless of the prevalence of phonological disorders among children you’ll want to take a look at your child’s development so you can find the best support for their individual needs.
Research has shown that children with phonological disorders are more likely to have difficulties with phonological awareness and literacy [3]. That’s why it’s important to seek treatment early on when children are developing pre-literacy skills.

Phonological Disorders Demystified