Speech Sound Disorder in Adults

The limited epidemiologic data that are available suggest that prevalence is slightly higher in boys than girls, and has a low positive correlation with socioeconomic status.

Speech sound disorder refers to any combination of difficulties with perception, motor production, and/or the phonological representation of speech sounds and speech segments that impact speech intelligibility. The disorder is characterized by:

• Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages
• Limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or any combination.

Speech sound disorders can impact the form of speech sounds or the function of speech sounds within a language. Adults with speech production difficulties may experience trouble with phonological knowledge of speech sounds or the ability to coordinate movements of the articulator (i.e, the jaw, tongue, and lips), with breathing and vocalizing for speech. A speech sound disorder is diagnosed when speech sound production is not what would be expected based on the child’s age and developmental stage and when the deficits are not a result of a physical, structural, neurological, or hearing impairment.

Signs and symptoms of speech sound disorders include:

• Omissions/deletions—certain sounds are omitted or deleted (e.g., "cu" for "cup")
• Substitutions—one or more sounds are substituted (e.g., "wabbit" for "rabbit")
• Additions—one or more extra sounds are added or inserted into a word (e.g., "buhlack" for "black")
• Distortions—sounds are altered or changed (e.g., a lateral "s")
• Whole-word/syllable-level errors—weak syllables are deleted (e.g., "tephone" for "telephone") or a syllable is repeated or deleted (e.g., "dada" for "dad")
• Prosody errors—errors occur in stress, intensity, rhythm, and intonation.

Not all sound substitutions and omissions are speech errors. Instead, they may be related to a feature of a speaker's dialect or accent. Any regional, social or cultural/ethnic variations should be taken into account before considering a diagnosis.

A number of studies have identified risk factors associated with speech sound disorders in children. These risk factors include male sex, oral sucking habits in infancy, ear, nose and throat problems, family history of speech and language problems, low facial muscle tone, inability to coordinate facial musculature, and low parental education.

If they are not successfully treated in the early years, functional speech disorders can persist into adulthood, often causing considerable distress. These adults may have difficulty pronouncing just one or two sounds, like /s/ and /z/ or just /r/, or just /l/. Adults often overcome these disorders, achieving "standard" speech sound production of any of the sounds that were previously in error.

autism, as well as in families of individuals with specific language disorders. However, having a genetic predisposition to social (pragmatic) communication disorder does not necessarily mean that someone will develop social (pragmatic) communication disorder.

Clinical research suggests the following treatments are indicated for the treatment of adults with speech sound disorder:

• Speech-Language Services: language intervention services facilitated by speech-language pathologists (SLPs) in a school environment that improve language, learning, and communication. The intervention is individualized to target the primary area of deficit (e.g., motoric articulation and/or phonological knowledge).
• Vocational Support Services: include testing to identify vocational strengths, career counseling, vocational training, job search assistance, and job coaching

Under the Americans with Disabilities Act (ADA), particularly Title I, employers are required to provide workplace accommodations for individuals with learning disabilities, but only for disabilities that have been disclosed. Individuals have the right to determine whether, when, how, and to whom to disclose their disabilities, and many choose to withhold disability information. The following sources provide recommendations of workplace accommodations for adults with learning disabilities: ADA and LdAmerica.org.

• Workplace Accommodations: Employers can provide possible solutions to remediate some of the challenges an individual with a writing impairment might experience in the workplace. Common adjustments are: minimizing oral presentation with written work; allowing extra time to express themselves (do not interrupt a slow speaker)

In addition, research suggests the following interventions are promising:

• Audiologist screening