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We've all heard it before – but it's time to rethink the way we interpret articulation norms.
Reviewing the article from by McLeod & Crowe's from Nov. 2020 , many of us have realized that we've been misinterpreting those speech acquisition charts. However, this still leaves many speech-language pathologists (SLPs) asking, "At what age should we address specific sounds in speech therapy?"
Questions like "When should I start treating /r/ errors?" or "Are /s/ errors still age-appropriate for preschoolers?" are common – but they’re the wrong questions to ask. If we base our decisions on arbitrary “cut-off” ages for sound acquisition, we’re missing the bigger picture. There's so much more to consider beyond what sounds a child can produce at a certain age.
Here are some key factors to consider:
Intelligibility: If a child isn’t at least 75% intelligible to unfamiliar listeners by age 3 (and 100% by age 4), it’s time to address their speech, regardless of what the charts say.
Phonological Processes: Not all sound errors are equal. A child might have all their age-appropriate sounds but still be deleting final consonants at age 3. This indicates the need for intervention to remediate phonological processes.
Underlying Structural or Functional Deficits: If issues like velopharyngeal insufficiency (VPI), tongue thrust, or other functional deficits are present, referrals or early intervention can make a big difference. Conducting an oral-facial exam is crucial for identifying or ruling out contributing factors to speech sound errors.
Multiple Errors: Even if all the errors are considered developmentally appropriate, a high number of errors affecting intelligibility means it's time to start treatment.
Family History of Speech or Learning Disorders: A family history of speech or learning difficulties should weigh heavily when determining the need for early intervention.
Impact on Literacy: We know that children with speech sound disorders are at a higher risk for literacy issues, particularly in phonological awareness, decoding, and spelling.
Social/Emotional Impact: If speech difficulties are causing a child to feel self-conscious, avoid speaking, or withdraw from social situations, don’t wait – intervene early.
Charts and norms are just one part of the puzzle. For instance, let’s look at the /s/ sound. When deciding whether to treat, I consider:
Impact on Intelligibility: If a child is 4 or older and not understood close to 100% of the time by unfamiliar listeners, it’s time to start intervention.
Type of Error: Whether the error is an omission, substitution, or distortion can influence when and how to start treatment.
Other Speech Errors: If a child has multiple speech sound errors, start addressing /s/ even as early as 3, especially if there are other challenges with speech development.
Red Flags for Myofunctional Disorders: Conditions like tongue thrust, mouth breathing, or a high/narrow palate should be treated or referred to another SLP with expertise in myofunctional therapy.
Lateral Lisp: Lateral lisps are not developmental errors, and kids don’t “grow out” of them. Start treating immediately.
I recognize that many school-based SLPs face the challenge of working within rigid eligibility guidelines and large caseloads. I’ve been there myself and understand the constraints. However, relying solely on speech acquisition norms as the threshold for eligibility can limit the support we provide to children and their families.
As we continue learning about complexity theory, reinterpreting speech acquisition charts, and understanding the connection between speech disorders and literacy, it becomes clear: there’s no one-size-fits-all "magic age" to start intervention for speech errors. It’s a far more nuanced process.