Do you or others have difficulty understanding what your child is saying?

February 6, 2019

Do you have difficulty understanding what your child says when he/she is talking to you?

Do your child’s grandparents, siblings, peers, or unfamiliar listeners have difficulty understanding your child as well?

Does your child seem frustrated when you ask him/her to repeat what he/she has said?

Does it seem like your child has a lot to say but at times their speech is difficult to understand?

If so, your child may be presenting with symptoms consistent with a phonological disorder. Below is a quick guide to what a phonological disorder is, signs of a phonological disorder, and information about the diagnoses and treatment.

What is a phonological disorder?

It is common for children to make mistakes when they are learning new words. However, if mistakes continue past a certain age and include phonological processes (the organizing of sound patterns) a phonological disorder may occur. It is important to note that every sound has a certain range of ages when a child should produce the sound correctly. This means that phonological processes are normal up until a certain age.

Signs of a phonological disorder (in children)

  • Difficulty being understood by familiar & unfamiliar listeners (decreased intelligibility). Included below is a helpful chart from Flipsen (2006) in determining intelligibility in young children. For example, at 1 year of age 25% of what a child says should be intelligible, or understood, by strangers.

Age 1;0

25% intelligible to strangers

Age 2;0

50% intelligible to strangers

Age 3;0

75% intelligible to strangers

Age 4;0

100% intelligible to strangers

  • Phonological processes that persist past a certain age
    • Phonological processes occur when children attempt to simplify adult phonological patterns. Phonological processes are developmentally appropriate and predictable. However, as stated above, they become problematic when they occur past a certain age.
  • Substituting sounds in words - For example, when the word cup à t This is an example of “fronting”, where a child who has difficulty producing sounds in the back of his/her mouth moves the sound to the front because it’s easier for them to produce.
  • Omitting sounds in words - For example, when the word star à _ This is an example of cluster reduction, where a child takes away one of the sounds in the word because it is easier for them to produce.

Who can diagnose & treat a phonological disorder?

Speech-language pathologists diagnose & treat phonological disorders. During the assessment process, the therapist would administer a questionnaire/conduct a parent interview, administer a standardized sound assessment, perform an oral mechanism exam, and conduct a play-based assessment to listen to your child’s conversational speech.

If a child is diagnosed with a phonological disorder, a speech-language pathologist can create an effective intervention plan tailored in response to your child’s errors.   Therapy would focus on auditory bombardment (inputting the target sound/patterns to the child via auditory methods), feature awareness (teaching the child the idea of the features needed for the child to make a system change), and production of the target sound/pattern during structured and unstructured activities. Treatment outcomes should increase your child’s ability to be understood by multiple communication partners and target the correct formation of sounds.

Nicole Maiellaro  M.S. CCC/SLP


Flipsen, P., Jr. (2006). Measuring the intelligibility of conversational speech in children. Clinical Linguistics & Phonetics. 20(4), 202-312.

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