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child:communication:speech-sound-disorder [on April 12, 2019]
child:communication:speech-sound-disorder [on March 29, 2021] (current)
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 == Comorbidity == == Comorbidity ==
-Language disorder (especially in those expressive deficits) may co-occur with speech sound disorder. Individuals may also have a history of delay or poor coordination involving facial musculature (e.g. - chewing, maintaining mouth closure, and nose blowing).+[[child:​communication:​language-disorder|Language disorder]] (especially in those expressive deficits) may co-occur with speech sound disorder. Individuals may also have a history of delay or poor coordination involving facial musculature (e.g. - chewing, maintaining mouth closure, and nose blowing).
  
 <callout type="​question"​ title="​What is the Timeline of Development of Speech?"​ icon="​true">​ <callout type="​question"​ title="​What is the Timeline of Development of Speech?"​ icon="​true">​
 In normal children, at age 2, only about 50% of speech may be understandable. By age 4, overall speech should be intelligible. By age 7, most speech sounds and words should be produced clearly and pronounced accurately. The most frequently misarticulated sounds are the "late eight" sounds (children may have difficulty with these sounds up until age 8 and this is normal). The sounds are (//l//, //r//, //s//, //z//, //th//, //ch//, //dzh//, and //zh//). In normal children, at age 2, only about 50% of speech may be understandable. By age 4, overall speech should be intelligible. By age 7, most speech sounds and words should be produced clearly and pronounced accurately. The most frequently misarticulated sounds are the "late eight" sounds (children may have difficulty with these sounds up until age 8 and this is normal). The sounds are (//l//, //r//, //s//, //z//, //th//, //ch//, //dzh//, and //zh//).
 </​callout>​ </​callout>​
-===== Diagnostic Criteria =====+===== DSM-5 Diagnostic Criteria =====
 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
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 Onset of symptoms is in the early developmental period. Onset of symptoms is in the early developmental period.
 == Criterion D == == Criterion D ==
-The difficulties are not attributable to congenital (i.e. - during fetal development) or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, [[cl:​tbi|traumatic brain injury]], or other medical or neurological conditions. Hereditary and genetic disorders (e.g. - Down syndrome) are excluded from this criterion.+The difficulties are not attributable to congenital (i.e. - during fetal development) or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, [[cl:​tbi|traumatic brain injury]], or other medical or neurological conditions. Hereditary and genetic disorders (e.g. - [[child:​genetic-disorders:​down-syndrome-trisomy-21|Down syndrome]]) are excluded from this criterion.
 </​WRAP>​ </​WRAP>​
 </​WRAP>​ </​WRAP>​
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 ===== Differential Diagnosis ===== ===== Differential Diagnosis =====
-  * Normal variations in speech+  ​* **Normal variations in speech**
     * Consider regional, social, or cultural/​ethnic variations of speech before giving the diagnosis     * Consider regional, social, or cultural/​ethnic variations of speech before giving the diagnosis
-  * Hearing or other sensory impairment+  ​* **Hearing or other sensory impairment**
     * Hearing impairment or deafness may result in abnormalities of speech. Only when the language deficits are in excess of what is expected, should a diagnosis of speech sound disorder may be made.     * Hearing impairment or deafness may result in abnormalities of speech. Only when the language deficits are in excess of what is expected, should a diagnosis of speech sound disorder may be made.
-  * Structural deficits+  ​* **Structural deficits**
     * Speech impairment can be caused by structural deficits such as cleft palate.     * Speech impairment can be caused by structural deficits such as cleft palate.
-  * Dysarthria+  ​* **Dysarthria**
     * Speech impairment can be due to a motor disorder such as cerebral palsy. This is dysarthria and not speech sound disorder. ​     * Speech impairment can be due to a motor disorder such as cerebral palsy. This is dysarthria and not speech sound disorder. ​
-  * [[anxiety:​selective-mutism|Selective mutism]]+  ​* **[[anxiety:​selective-mutism|Selective mutism]]**
     * Limited speech might be due to selective mutism. Selective mutism may develop concurrently in children with speech disorder due to embarrassment about their impairments. Most children with selective mutism have normal speech in comfortable environments,​ such as at home or with friends.     * Limited speech might be due to selective mutism. Selective mutism may develop concurrently in children with speech disorder due to embarrassment about their impairments. Most children with selective mutism have normal speech in comfortable environments,​ such as at home or with friends.
 ===== Treatment ===== ===== Treatment =====