Articulation disorders: causes and treatment approaches

Articulation disorders: causes and treatment approaches

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Articulation disorder in adults and children
If children cannot correctly pronounce sounds, there is probably an articulation disorder - in technical jargon dyslalia. Those affected omit sounds entirely, replace them with others or pronounce them in a distorted manner.

Missing sounds in the mother tongue

Speech therapists treat speech disorders especially in children. But adults also make mistakes when making sounds. Problems related to mother tongue do not count as a disturbance for them: For example, many East Asians cannot pronounce R because it does not appear in their languages. Many Germans cannot roll the R like in Spanish, and most Central Europeans fail because of the different sh-sounds of the Slavic languages. The click sounds of the San are extremely difficult for Indo-European native speakers.


On the other hand, the lisping of adults, i.e. the inability to make sibilants, is considered a disturbance. In contrast to toddlers, who find sch, s and z equally difficult, adult Lisplers have almost exclusively deficits, s and z: they only form these sounds with the tongue between the teeth, instead of forming a soft S behind the teeth.

Lisping is easier to correct through training in childhood than in old age. Many adult Lisplers were unable to pronounce the sch correctly as children, but learned this with or without training. But they kept the wrong pronunciation of the s and z, also because a slight lisp at s or z is less noticeable in German.

Lispel usually increases in certain situations, for example when the person is severely agitated or lacking concentration, when they are under stress or when they consume alcohol and drugs.

Problems with sound formation

This lack of sound is the only symptom of this disorder, unlike other speech disorders. Anyone suffering from dyslalia has no problems with vocabulary, grammar or sentence structure, and this child does not lack an understanding of the language.

If, on the other hand, people have problems putting sounds in the correct place in the word and sentence, we speak of phonetic disorders. If children under the age of five omit, replace or mispronounce sounds, it is not a disturbance. Five-year-olds also often mispronounce one or two sound groups, for example t and d or s, z, sch and ch, or f and w.

The most common disturbance of articulation is errors in the pronunciation of s, z, sch or ch. These are usually pronounced with the tongue between the teeth, and many children have problems using the tongue correctly.

The second most common disorder after the sibilance of making sibilants is the sounds k and g, which many children replace with t or d.

However, if these speech errors are noticeable, parents of five-year-olds should consult a doctor or speech therapist so that these specialists can clarify whether the articulation is disturbed.

How is lisp made?

The technical term for lisp is sigmatism. With sh, for example, the air normally only escapes through the front teeth and we make the sound with the mouth closed. Depending on whether and how close how close we press our tongue to the front teeth or the gums in the upper jaw, the sound is sharper.

If the air also comes out of the mouth through the side rows of teeth, the bl blurs with s and z to a tszsch, sszsch, a szschtsch or similar. The supreme discipline for Sch-Lute is Russian, in which there are a total of five different Sch-Lute, from the soft jsch to a chsch to a sharp ttsch.

If you suffer from a strong sigmatism when shouting, you shove your tongue between your teeth and produce a sharp S. He or she says nice instead of pretty and quick instead of quick.

In “classic” lisp, however, those affected make all s and z sounds like the English th in the word think.

Psychological consequences?

Slight lisping doesn't particularly hinder adults either. However, if the lisp is pronounced and there is an imprecise pronunciation, communication suffers because other people have problems understanding the people affected.

For people who have to speak publicly, professionally or privately, serious problems often arise. These can be of a psychological nature because listeners make fun of the pronunciation of those affected or even question their intelligence.

This is especially true because lisp is often a learning error that can be remedied by training. In circles that value etiquette, this articulation disorder is therefore often seen as a sign of a lack of upbringing: those who lisp have a reputation similar to that of someone who puts their elbows on the table while eating.

On the other hand, even politicians, business people and even pop stars develop a lighter sigmatism even as their trademark.

Lispeln is not always due to mistakes in learning pronunciation, but can also be caused or promoted by the teeth of the person concerned. For example, if you have crooked front teeth with large gaps, you automatically lisp, and it is much more difficult for you to learn the correct articulation of s, z and sch than for people with straight teeth.

Combined speech disorders

In practice, articulation and phonological disorders cannot always be separated. Anyone who replaces sounds, for example saying instead of embarrassing or embarrassing a cup, often has a phonological disorder.

Speech therapists now examine the entire articulation of the person concerned. If someone replaces sounds, for example, but can correctly form the individual sounds like sch, s or z, it is not primarily a problem with the articulation, but a problem of forming the right sounds in the right place.

If affected children have additional problems, for example if they only breathe with their mouths, if saliva runs out of the corner of their mouths or if they cannot coordinate the movement of their facial muscles properly, this is also not a mere articulation disorder.

We also distinguish primary from secondary articulation disorders. Which is a disorder in language development. However, secondary articulation disorders follow different basic complaints.

For example, hearing impaired people often develop disturbances in pronunciation because they do not understand the sounds properly. The sibilants in particular are difficult to tell apart in the case of hearing problems. In addition, diseases in the mouth can be the cause that those affected neither learn nor use the pronunciation correctly. This includes, for example, the cleft lip and palate, popularly known as Hasenscharte. Even a slight muscle tension in the mouth prevents correct pronunciation.


Most articulation problems arise with sounds that are formed very similarly and differ only subtly. For example, "roof" sounds like "day" when the pronunciation is inaccurate.

It is up to the parents to practice correct pronunciation with the children early on. Most articulation disorders arise because children learn the wrong pattern of sounds. However, since we automate language patterns, the longer the child uses this language, the more difficult it is to correct the errors.

Most articulation disorders are not caused by organic complaints, but simply because children make inaccurate sounds. They are therefore particularly common among children who are learning to articulate language, i.e. between the ages of 4 and 6.

The diagnosis

Speech therapists use tests, screenings, comparisons and game simulations in which children speak spontaneously to determine whether those affected have problems articulating themselves.

To differentiate an articulation disorder from an understanding, the so-called phonemic discriminatory ability, simply put, is the test whether the children can differentiate the sounds in terms of content. For example, do you know the difference between cup and bag and paw or cat and cash register?

In addition to the speech therapist, the ear, nose and throat doctor is also in demand. He checks whether there is a hearing impairment. This test is particularly important today: Many hearing impaired suffered from the fact that teachers and parents considered them stupid or disobedient in their childhood because they did not hear what they said and therefore had problems making sounds themselves.

Therapy for articulation disorders

Speech therapy is geared towards the individual and their age, interest and abilities. The affected children are actively involved, which means that they should assess the pronunciation of others and their own.

The speech therapist first trains listening. Then the children learn to make the faulty sounds in isolation using various methods. If they are successful, use sch, s and z or d and t in syllables, words and sentences.

Therapy is most effective when the children learn while playing. The motivation of those affected is very important. The parents are asked to pick up the thread and to implement what they have learned in the game.

Are articulated people stupid?

Disorders in sound formation are not a sign of a lack of intelligence. In all age groups and in all schools, people with articulation disorders perform the same as their peers.

A third of those affected, however, show psychological abnormalities that presumably promote articulation disorders. Disturbances in concentration and attention such as motor restlessness are typical. These are deficits that generally lead to problems in differentiated learning. Those who cannot concentrate, for example, tend to make generalizations because they only keep the headings of a text. Those who are inattentive confuse terms, words and topics that only arrive as fragments in their long-term memory.

When it comes to correct articulation, differentiation is important: those affected confuse letters that are pronounced very similarly. In a nutshell, this also applies to people who confuse Karl Marx with Karl May or develop a diffuse worldview that consists of associations with what they “picked up here and there”.

Causes of articulation disorders

To date, there are few verifiable meta studies on articulation disorders. Presumably, it is primarily a delayed speech development due to disorders in the central nervous system. It is not a psychosomatic disorder like many stutterers, and it is also only conditionally a lack of support at school and at home. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • German Federal Association for Speech Therapy e. V .: Articulation disorders, (accessed 09.09.2019), dbl
  • Ger.Ges. f. Child and adolescent psychiatry and psychotherapy etc. (Ed.): Guidelines for the diagnosis and therapy of mental disorders in infancy, childhood and adolescence, circumscribed articulation disorders, Deutscher Ärzte Verlag, 3rd revised edition 2007 - ISBN: 978-3-7691-0492-9, p. 189 - 195 (accessed 09.09.2019), AWMF
  • Martina Weinrich, Heidrun Zehner: Phonetic and phonological disorders in children - dyslalia therapy in motion, Springer Verlag, 3rd edition, 2008

ICD codes for this disease: F80.0ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: Intro to Treatment of Phonological Disorders (November 2022).