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When an organic problem that could affect articulation exists, but its effects are not observed, the clinician usually concludes that the child has learned a compensatory response. The patient with this type of aphasia speaks in a slow, halting manner with telegraphic speech with few or no grammatical features. Orthodontists often refer children with deviant swallow to speech-language pathologists for myofunctional therapy, which is treatment aimed at correcting tongue thrust. There is controversy about whether deviant swallow causes articulation problems and whether correcting deviant swallow is the work of speech-language pathologists. Orthodontists, specialists who treat people with misaligned teeth and upper and lower dental arches, are concerned with tongue thrust because of the belief that tongue thrust works against orthodontic treatment. Some children who have difficulty producing speech sounds may be apraxia of speech and possible neurological involvement. Another speech disorder of neurological origin that includes speech sound errors is called apraxia of speech. Central or peripheral nerve damage causes a group of speech disorders called dysarthria. When the parts of the brain or various nerves that control speech muscles are damaged, speech production is affected. Various diseases and accidents can damage portions of the central nervous system concerned with speech production. Although most children with speech sound disorders do not show gross neurological problems, neural damage of various kinds tends to cause those disorders, along with other communicative problems. Individuals with hearing impairments are likely to omit consonants in the final and initial positions. Severe hearing loss makes it difficult not only to hear other people's speech but also to monitor one's own speech production. Hearing loss causes a variety of oral speech and verbal language problems. People who do not learn compensatory responses show problems of speech sound production. In essence, the child will have learned unusual ways of producing the target sounds. It was once thought that low intelligence might be a cause of speech sound production problems. Malocclusion is a problem of misaligned upper and lower dental arches. The effects of malocclusion of the dental arches on speech sound production has been a topic of several studies. If the lingual frenum, which attaches the tongue to the base of the mouth, is too short, the range of the tongue-tip movement is reduced. In a few cases, tongue-tie, also known as ankyloglossia, may be an organic cause of speech sound production problems. Lips, teeth, tongue, and hard and soft palates are all involved in speech production. Clearly hearing and understanding differences between speech sounds is known as auditory discrimination. Because the production of speech is a motor task, difficulty in speech sound production suggests deficiency in general or speech-specific motor skills. Most children with language disorders tend to exhibit speech sound disorders. Children with less severe speech sound disorders may not show language delay or disorders. The children may be less proficient in using complex sentence structures. There is some evidence that firstborn and only children have better articulation skills than do children who have older siblings. A majority of children with intellectual disabilities have multiple errors of articulation. Although in a majority of children speech disorders are not associated with limited intelligence, significant intellectual disabilities are frequently associated with such disorders. Indeed, the intellectual levels of many children who are treated for problems of speech sound production fall within the typical range.
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