Pronunciation Errors: Preventing Dyslalias in Children

The term dyslalia refers to the difficulty in the correct articulation of one or more phonemes of a language, in the absence of a pathology in the central nervous system.

Dyslalia can affect the production of both consonantal and vowel phonemes; a single phoneme (simple dyslalia) or several (multiple dyslalia). Thus, it can cause in the patient from a distorted but intelligible speech to a completely distorted and therefore unintelligible speech.

Main causes of dyslalia in children

1. Evolutionary: it is part of the normal process of language acquisition by the child, i.e. the child learns and repeats the word with an incorrect sound.
2. Functional
   1. Productive: has a motor basis: they are phonetic disorders in which there is a difficulty in articulation, point and sonority.
   2. Perceptual: these are phonological disorders in which there is a difficulty in perception and discrimination. Errors in the recognition of distinctive features and in the combinatory rules of phonemes.
3. Audiogenic: for a good speech production is necessary a good hearing, so the child with a hearing loss will not speak spontaneously or if he/she has a hearing impairment will speak distorted, especially in the phonemes that are similar due to the lack of auditory discrimination.
   Depending on the degree of hearing loss, a distortion in the voice and rhythm may be observed, a cause of alert for a possible deafness.
4. Organic: they are those produced by an organic disorder. If the lesion is at the neurological level, it is called dysarthria; while if the lesion is in any of the organs involved in the articulation of sounds due to malformations or anomalies, it will be called dysglossia. Of the latter, the most common is cleft lip with or without cleft palate.

Types of dyslalia errors

• In the beginning, the so-called simple dyslalia may occur, where the alteration is only of one phoneme, such as multiple /R/.
• If several unrelated phonemes are affected, it will become an isolated multiple dyslalia.
• If the dyslalia affects a whole group of sounds, it will be called systematic multiple dyslalia (for example, the substitution of all fricative sounds by occlusives).
• If the dyslalia is more extensive and there are phonemes that are related between them and others that are not, it will be called generalized dyslalia.

The pronunciation errors that occur in dyslalia can be diverse:

• substitution: the phoneme is replaced by another, usually close to the point of articulation, dog -but/pedo – red-lojo.
• omission: where the phoneme is omitted with difficulty to articulate (balloon-gobo) (flor-fo).
• insertion (epenthesis): a phoneme is inserted into the syllable (plato-palato).
• distortion: for example the case of lateral sigmatism, where the /s/ is distorted by the lateral outflow of air.

Warning signs of dyslalia Which children may develop pronunciation problems?

There are many signs that, if we look closely, can serve as a guide to determine if a child is a candidate to develop one or more dyslalias. Other times with simple observation, you can refer to the speech therapist to perform an examination and assess the need or not of a possible intervention.

• Psychological factors that may lead to the development of dyslalia in children:
  • Affective disorder
  • Separation from parents
  • Jealousy
• Lack of auditory discrimination:
  • Repeated colds
  • Hearing loss: serous otitis (loss of 30 to 50dB maximum)
  • Hearing loss
• Environmental factors:
  • Multilingual environments
  • Dialectal variants of the same language
  • Adults speaking with dyslalia
  • Older siblings with dyslalia
  • Cultural environment
• Factors due to organic alterations:
  • Cleft palate
  • Cleft lip
  • Adenoid hypertrophy
  • Tonsillar hypertrophy
  • Velar insufficiency
  • Lingual frenulum
  • Ogival palate
  • Macroglossia
  • Prognathism
  • Poor dental implantation
• Bad habits:
  • Thumb sucking
  • Oral breathing
  • Masticatory difficulties
  • Swallowing disturbances (atypical swallowing)
  • Suction of the lower or upper lip

Exercises to prevent dyslalia in children

These are some examples of activities that can be developed at home or at school, taking advantage of an activity in the classroom, for example with a story or a song. Through these, we can exercise children’s pronunciation and prevent dyslalia.

1. Breathing and blowing
   1. Breathing in through the nose and out through the nose
   2. Breathe in through the nose and out through the mouth.
   3. Holding one nostril, breathe in through the other nostril.
   4. Breathing in through the nose and blowing out very hard
   5. Breathing in through the nose and blowing out very softly
   6. Breathing in through the nose and blowing 2, 3, 4… times
      There are a thousand combinations that we can alternate to train our blowing: loud, soft, imitating animals… How we would blow if we were…? with vocalizations, etc.
2. Tongue, lip, cheek and mandibular praxias.
   1. Tongue exercises:
      1. With the mouth wide open stick the tongue out and stick it inside the mouth.
      2. Pass the tip of the tongue through the upper alveoli from one side to the other quickly.
      3. Touch the tip of the tongue to the upper and lower lip.
      4. Stick out the tongue to the right of the corners of the mouth (10 times) and do the same exercise to the left.
      5. Tongue to the cheeks inside the mouth (like a massage).
      6. Follow the upper incisors with the tongue and then the lower incisors with the lips together.
      7. Place the tip of the tongue in the lower alveoli and make alternating upward and flattening movements.
      8. Clicking the tongue
      9. Tongue vibration between lips
      10. “RRRRR” sound.
   2. Lip exercises:
      1. Naturally closed lips.
      2. Smile with lips together and smiles showing teeth.
      3. Projecting pursed lips (pouting).
      4. Alternate smiling with lips together and projection
      5. Projecting lips forward, opening and closing the mouth orifice (fish)
      6. Forceful kissing in different positions (outward, right, left)
      7. Vibration of lips (brrrrrr)
      8. A-O-U / U-O-A aphonic utterance
   3. Cheek exercises:
      1. Inflate the cheeks with air.
      2. Alternate a phlegm of air to the right and left.
      3. Push the cheeks outwards with the tongue.
      4. Pinching the cheeks.
      5. Massage the cheeks. Jaw exercises:
      6. Opening and closing the mouth
      7. Moving the jaw from side to side
      8. Jaw rotation
      9. Yawning
3. Auditory discrimination and rhythm:
   1. Discrimination of different sounds such as: animal, environmental, own body, instruments….
   2. Discrimination of pitch, intensity and duration of a sound.
   3. Discrimination of specific phonemes by or without opposition to others (see tables).
   4. Imitation of rhythms with the hands, with the feet, with the whole body…
4. Onomatopoeias:
   Making noises imitating the sounds of:
   1. animals
   2. own body
   3. environment
   4. objects
   5. means of transportation
5. Imitative, directed, spontaneous language
   1. Repeating words spoken by the teacher: for example, words with the initial phoneme /p/.
   2. Saying words containing a given phoneme
   3. Completing sentences
   4. Saying proverbs
   5. Poetry
   6. Songs

Can dyslalia be treated in adulthood?

Although most dyslalia develop during childhood, it is not a problem to treat them in adulthood. The treatment in both children and adults, always goes through a first exploratory visit where the problem will be assessed, the treatment to follow and the referral to other professionals if necessary.