Speech and Language Disorders in Children: Speech Sound, Language, Fluency, and Voice
Domain 2 tests differential diagnosis and management planning across pediatric speech sound disorders, developmental language disorder, stuttering, and voice disorders. Questions often ask you to distinguish an articulation error from a phonological pattern, normal disfluency from stuttering, and a language difference from a language disorder.
Core rules
- Speech sound disorders include articulation-based distortions and phonological pattern errors. Consider age norms, stimulability, intelligibility, error consistency, and participation before deciding severity or target selection.
- Developmental language disorder affects comprehension and/or expression and is not explained by hearing loss, intellectual disability, or another biomedical condition. Assess vocabulary, grammar, narrative, pragmatics, and functional communication.
- Normal disfluencies include whole-word and phrase repetitions, revisions, and interjections. Stuttering risk rises with part-word repetitions, blocks, prolongations, tension, avoidance, negative reactions, and a family history.
- Persistent childhood hoarseness warrants laryngeal examination; do not treat it as only a behavior problem.
Worked example
A 6-year-old produces a lateral /s/ but all other sounds are age-appropriate, intelligibility is good, and no phonological pattern is evident. The child can produce a central /s/ with placement cues. This is better described as an articulation-based distortion than a broad phonological disorder. Intervention should target motor placement, auditory discrimination, and carryover into conversation rather than a full phonological cycling program.
Traps
Do not diagnose stuttering from normal whole-word repetitions. Do not assume every /r/ error at age 5 is disordered without considering norms and stimulability. Do not overlook voice, hearing, or oral-motor findings. Do not plan goals that are not measurable in real communication.