Why Articulation Norms Don't Matter That Much...

Yup... I said it.  Given all the buzz from that McCleod & Crowe article last year, it should be no secret that we've totally been misinterpreting those articulation norms. But, for a lot of SLPs it still begs the question... "then at what age should we be addressing particular sounds in speech therapy?"

Some of the most common questions I hear from SLPs sound something like this:

"When should I start treating kids for /r/ errors?"
... or ...
"Aren't /s/ sound errors still age appropriate for preschoolers?"

Those are the WRONG QUESTIONS.

If we base eligibility criteria and/or target selection primarily on arbitrary "cut-off" ages for acquisition of sounds, then we're missing the whole point. There are so many other variables that should be considered in addition to what particular sounds a child has at a particular age...

• Intelligibility... if a child isn't at least 75% intelligible to unfamiliar listeners by the age of 3 (and 100% by age 4), then it's time to address speech, regardless of what the charts say.
• Presence of phonological processes... all sound errors are not created equal. Maybe a child has all their "age appropriate" sounds, but they're still deleting final consonants at the age of 3.  Time to treat and remediate that phonological process! #phonologyisnotarticulation
• Underlying structural or functional deficits... if things like VPI, tongue thrust, etc. are present, making referrals or getting a jump on speech intervention can be hugely beneficial. This also highlights the importance of ALWAYS administering an oral facial exam whenever possible. It can help you uncover or rule out issues that could be contributing to speech sound errors and help you make necessary referrals to other professionals.
• Presence of multiple errors... even if all those errors are "developmentally appropriate", if there's a bunch of them and they're significantly reducing speech intelligibility, don't wait!
• Family history of speech difficulties or learning disabilities...  this is a big one!  If you know there is a history of speech/learning disorders in the family, that's definitely something to consider when recommending services. So make sure you're doing your best to get a super thorough case history!
• Difficulty learning to read and/or write... we know that children with speech sound disorders are at higher risk for having literacy related deficits, especially in the areas of  phonological awareness, decoding, and spelling.  So much more about that from Dr. Kelly Farquharson here.
• Social/emotional impact... if a child is self-conscious about their speech difficulties, if it's inhibiting participation in their school or community, or if they're avoiding speaking in certain situations, please don't wait to treat.

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I like a good bar graph as much as the next guy... but I have to remind myself its just one piece of a bigger puzzle.

Let's take the /s/ sound, for example. Here are some factors I take into consideration when I decide whether or not to recommend speech therapy:

1. How much do the child's speech errors impact intelligibility? Usually a simple frontal lisp doesn't impact intelligibility too much, but if they’re 4 years or older and strangers can’t understand them close to 100% of the time, then it’s time to treat.
2. Are they omitting, substituting, or distorting the /s/? I may consider treating earlier or later depending on whether they are reducing consonant clusters or stopping vs lisping. Again, phonology is not articulation.
3. Are there any other speech errors? If you’re already treating this child, for the love of speech sound disorders, please start treating /s/... even at 3! We already know they have trouble acquiring speech, so get a jump on it!
4. Are there red flags for a myofunctional disorder? This deserves a post in itself... But, if there’s a tongue thrust, low tongue resting position, mouth breathing, high/narrow palate (I could go on and on), by all means don’t wait! Treat the underlying myofunctional deficit or refer to an SLP who can.
5. Is it a lateral lisp? TREAT NOW. That’s not a developmental error and kids don’t “grow out” of it. I developed the Bjorem Speech Sound Cues for Lateralization for this particular speech sound disorder, which I've found to be so helpful with little ones who have such a hard time understanding correct placement.

​Now, I completely understand that many school-based SLPs are all too often bound by black-and-white eligibility guidelines put in place by administrators with little to no understanding of the nuances of SSDs.  And believe me, I can totally empathize with the concerns over gigantic caseloads in light of all these considerations (I was a school-based SLP for many years, myself). Unfortunately, I have no easy answers.  I just know that we do our kids and their families a disservice when we solely rely on speech acquisition norms as an arbitrary threshold for eligibility criteria.

With everything we’re learning about complexity theory, how we’ve been misinterpreting those speech acquisition charts, and how speech delays/disorders can impact literacy... it becomes pretty clear that there really is no “magic age” at which we should begin providing intervention for kids with errors of particular sounds. It’s much more complicated than that.