32 Chapter 2
the conf lict or psychological need, and patients are said to have a symptom choice; their symp-
toms symbolize the conf lict or need. Loss of speech and hearing suggests interpersonal conf licts
or impoverished communication. Articulation delay and regression also may be psychological in
etiology and are usually classified as elective mutism or idiopathic articulation disorders.
Normal children do not regress significantly in articulation development; a 5- year- old child
does not normally use the speech of a toddler. When significant regression occurs, it is usually
neurologically based or a result of psychological trauma. The psychological trauma may be the
loss of a loved one through divorce, separation, or death or because of neglect and abuse. A period
of mutism often precedes regression of speech and language abilities that is typical of hysterical
stuttering (Van Riper, 1992). The regression in speech articulation is related to the child’s return
to a more secure and comfortable psychological state, with speech patterns ref lecting that coping
style and defense mechanism. In children with speech articulation disorders related to emotional
stress, treatment should also include a psychological referral and reports to an appropriate social
agency in cases of suspected neglect and abuse.
In the phonological approach to articulation disorders, the child simplifies adult phonology and
is delayed in learning age- appropriate phonological rules. “In his or her attempts to use language,
the child in effect makes systematic simplifications of the phonology. From this point of view,
children with a phonological disorder continue to use a simplification pro cess beyond the time
when others [of] their age use them” (Plante & Beeson, 2004, p. 65). In the phonological approach,
the child with articulation errors has a delay, in contrast to a child with an articulation disorder.
Sensorimotor articulation inadequacies, as described here, refer to children who have one or
two articulation disorders and have not mastered those par tic u lar phonemes at age- appropriate
times. Isolated lisping and /w/ for /r/ substitutions are typical sensorimotor articulation errors that
can be viewed not as a larger phonological disorder, but as an impairment or deficiency in audi-
tory perception and in learning fine oral- motor speech skills. However, the articulation disorders
originally may have been part of a larger phonological disorder and a simplification of adult pho-
nology; the two theories are not mutually exclusive. Culbertson and Tanner (2001a, 2001b) have
shown the strong relationship between neuromotor maturation and phonological development.
Because of auditory perceptual and oral- motor habit strength, many children who lisp and have
isolated /w/ for /r/ substitutions simply need traditional articulation therapy, not global phonology
development therapies.
Diagnosing Articulation and Phonology Disorders
Diagnosing articulation and phonology disorders is sometimes called the three- by- three sys-
tem. In this system, three types of articulatory errors are identified in the initial, medial, and final
positions of syllables and words: omissions, distortions, and substitutions.
An omission is the deletion or neglect of a par tic u lar phoneme that should occur in a syllable
or word. For example, a child may say “at” for “cat” or “ee” for “see.” In phonology, omissions occur
as part of changes in the structure of the syllable when the child simplifies speech by omitting a
phoneme or phonemes. For example, omissions occur with cluster reduction, deletion of final
or initial consonants, deletion of unstressed syllables, and syllable reduction. Clinicians identify
omission on the rec ord sheet by writing “om” where the phoneme should occur.
A distortion is the substitution of a nonstandard phoneme. The child produces a sound not
recognized in his or her language system (however, it may be a recognizable phoneme in another
language). Increasingly severe distortions are recorded as D 1 , D 2 , and D 3 , respectively. A nasal
distortion in which there is audible escape of air through the child’s nose (nasal emission), or
hypernasality, is identified as D- nasal.