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Speech Therapy

Articulation, Phonology & Apraxia.


“Articulation” refers to how your child uses their jaw, their teeth, and the muscles in their lips and tongue to produce specific, individual speech sounds. Difficulty saying certain sounds is expected as children learn how to use these structures appropriately. They may also leave out certain sounds they have not yet mastered or add other sounds to words in order to make them easier to say. However, when a child leaves out/adds sounds, or produces sound substitutions or distortions for specific sounds beyond the age by which they are expected to say the sound, speech therapy may be necessary.

Monkey Mouths Articulation, Phonology & Apraxia
Monkey Mouths Articulation, Phonology & Apraxia


“Phonology” refers to predictable patterns a child may use to produce certain types of speech sounds. Unlike articulation errors, which are singular distortions or substitutions, phonological errors occur on multiple sounds. Examples of phonological patterns include, fronting (e.g., replacing “g” with “d” in “bag” to produce “bad”, or “k” with “t” in “kid” to produce “tid”), stopping (e.g., replacing “s” with “t” in “soap” to produce “toap”, or “f” with “p” in “leaf” to produce “leep”), and final consonant deletion (e.g., leaving off the final sound in words, such as omitting the “g” in “pig” to produce “pih”). As your child learns the sound system of language, certain phonological processes are appropriate. However, if your child continues to use these phonological processes past the expected age, speech therapy may be necessary.

Cause of speech sound disorders

The cause of articulation and phonological speech sound disorders is typically unknown, unless a child has other diagnoses such as cleft lip/palate, Down syndrome, or cerebral palsy, which cause structural differences. Hearing loss or difficulty with phonological or auditory processing may also cause difficulties with producing specific speech sounds. If your child cannot hear a sound, they will have difficulty learning to produce it. Likewise, difficulty discriminating between speech sounds will cause your child to have difficulty producing them. If your child has not had a recent hearing screening or evaluation (within the last year), updated testing will be necessary to determine whether your child’s ability to hear impacts their success producing speech sounds. This testing can be conducted at Monkey Mouths Southlake location.


Monkey Mouths therapists use various assessments to evaluate articulation and phonological disorders. We will assess your child’s productions of sounds in words and in connected speech, to determine which contexts are most successful. If fluency, use or understanding of language are also a concern, we will evaluate in those areas, as well. During an articulation evaluation, Monkey Mouths therapists also conduct thorough oral mechanism examinations. Oral mechanism examinations assess whether the structure and function of a child’s speech mechanisms (e.g., lips, tongue, teeth, and jaw) are adequate for speech sound production.


After completing a comprehensive evaluation, your therapist will create an individualized treatment plan to address all sounds or sound systems which are difficult for your child. Goals will be selected based on which age-appropriate sounds are difficult for your child and in which contexts they are able to say them.

Treatment approaches for speech sound disorders used by Monkey Mouths therapists include the following:

Apraxia of Speech

Childhood Apraxia of Speech (CAS) is sometimes called verbal dyspraxia or developmental apraxia; however, CAS is not a diagnosis that a child outgrows. Children with apraxia of speech know what they want to say, but they have difficulty planning and coordinating the muscles of the mouth in a manner to produce intelligible speech. As with most diagnoses, the severity of CAS can vary widely among individuals. 

Some common characteristics of CAS are the following.

If you have these concerns, please consult with your primary care physician to determine if a speech evaluation would be recommended.

Sound Card System

The Sound Card System- also known as SCS or “the Monkey Mouths cards”- is a proven method for improving speech skills. The Sound Card System was designed for parents to use at home, where the real work happens in speech therapy. The system is designed around visual, verbal, and tactile clues. Our founder, Erin Bernett, pioneered the Sound Card System (SCS) over 25 years ago and continues to refine this hands-on methodology for helping children (and their parents) motor-plan for vowel and constant sounds in words.

Monkey Mouths Articulation, Phonology & Apraxia
Monkey Mouths Articulation, Phonology & Apraxia
Monkey Mouths Articulation, Phonology & Apraxia

Bilingual Patients

Learning two languages does not cause delays in your child’s speech and language. If a child has difficulty making a sound that is present in both languages, this would be considered a disorder. For example, the “b” sound is present in both English and Spanish. So, if a child could not say, “baby” or “bebé,” due to difficulty with the “b” sound, this would be considered an articulation or phonological disorder.

Some speech sounds are only used by one language. For example, Spanish does not use the “th” sound, as in “this,” so a child whose primary language is Spanish would naturally have difficulty producing this sound and might say, “dis,” instead. This would be considered a difference, not a disorder. Special considerations are taken for bilingual patients, regarding whether speech sound errors are due to true articulation/phonological disorders or because the sound in error is not present in both languages.

Monkey Mouths, Bilingual Services