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It is suggested that when the siblings are too close to each other in age, the slightly older sibling may provide a model of atypical speech production for the younger child. In a few cases, tongue-tie, also known as ankyloglossia, may be an organic cause of speech sound production problems. Therefore, in a majority of cases, speech sound disorders cannot explained by significant structural anomalies. However, most children who misarticulate have normal lips, tongue, and palates. Lip, teeth, tongue, and hard palate and soft palates are all involved in speech production. Some children with misarticulations have scored poorly on auditory discrimination tests, whereas others have scored within the typical range. If the child cannot hear the differences between /s/ and /z/, then that child's substitution of /s/ for /z/ may be due to this lack of auditory discrimination. Studies of speech-related motor skills also have not produced anything significant except the idea that the children who misarticulate may be slower in repeating syllables. Clearly hearing and understanding differences between speech sounds is known as auditory discrimination. The children may be less proficient in using complex sentence structures. Because the production of speech is a motor task, difficulty in speech sound production suggests deficiency in general or speech-specific motor skills. Research has shown that socioeconomic status is not a strong factor in the etiology of speech sound disorders. However, 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. Studies have shown that the language development of children with severe speech sound disorders is somewhat delayed. Because speech is a part of language, researchers has examined the relationship between language development and misarticulations. The approach of describing individual errors involves a sound-by-sound analysis of misarticulations. There is some evidence that firstborn and only children have better articulation skills than do children who have older siblings. Other studies have reported that children from lower classes make more errors of articulation than those in the upper classes. Nevertheless, more children in the lower socioeconomic classes than in the upper classes have errors of articulation. A majority of children treated for these disorders in speech clinics are boys. Nonetheless, more boys than girls tend to have speech sound disorders. There is some evidence that female children generally have slightly superior articulatory skills than do male children. 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. However, several studies have shown that children with typical levels of intelligence can also have difficulty learning speech sounds. It was once thought that low intelligence might be a cause of speech sound production problems. The treatment is directed toward eliminating a persisting faulty phonological pattern instead of individual sound errors. A phonological pattern is a clinical problem in need of remediation only if it persists beyond the typical or average age at which it is supposed to disappear. In these cases, the omitted sounds are in the final position within the words.
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