Dyslalia: what it is, causes and treatment

When a child says "tato" instead of "gato" (cat) or "pato" instead of "prato" (plate), many adults find it funny and say, "It's normal, they're learning." In many situations, this is true. But in other cases, these errors can be a sign of dyslalia, and it's important to understand them better so as not to miss something important.

Dyslalia is a speech articulation disorder, very common in childhood, in which the child substitutes, omits, or distorts certain phonemes, making speech less clear to the listener.

Although it's normal for speech errors to occur up to a certain age, when these difficulties persist, they can affect self-esteem, interaction with other children, and even learning to read and write.

In this article, we will explain in a simple and complete way what dyslalia is, its causes and treatment, the warning signs, and how it is diagnosed. Speech therapy, What results can you expect and what can you do at home to help the child?.

Dyslalia: what it is and how it manifests in daily life

Dyslalia is a speech disorder in which a person has difficulty correctly articulating certain sounds (phonemes), despite having hearing, intelligence, and overall development within the expected range.

In simple terms:

• The child substitutes one sound for another.

  • Example: “tato” instead of “gato”, “papo” instead of “prato”

• Omission of sounds

  • Example: “ato” instead of “gato”

• Distortion or "strange sound"“

  • The sound is produced, but in a different way than expected.

In dyslalia, the child knows what they want to say, has ideas and vocabulary, but the way they articulate the sounds prevents the message from coming out clearly. That is why it is classified as... articulatory disorder or phonological, focused primarily on the production of speech sounds.

Dyslalia and normal speech development

Not all pronunciation errors are dyslalia. To avoid over-labeling, it's crucial to understand what is expected at each age and when these errors become a sign.

In the first years of life, it's normal for speech to be simplified. Until around age 3, many children:

• They replace more difficult sounds, such as the strong /r/ or groups like “pr”, “tr”, “cl”

• They simplify long words.

• They are still difficult for people outside the family to understand.

This phase can be informally called "developmental dyslalia," meaning a set of typical developmental errors that tend to disappear as the child matures.

On the other hand, we begin to think of dyslalia as a disorder when:

• After the age of 4, speech remains very unclear.

• The child makes substitutions, omissions, or distortions in many sounds.

• Adults outside the family have difficulty perceiving it.

• The child becomes frustrated because no one understands them.

In these cases, we are no longer simply dealing with immaturity. We are clearly in the area of dyslalia, and it is worthwhile to seek an evaluation in speech therapy.

Main warning signs of dyslalia

For many parents, the biggest question isn't so much "what is dyslalia," but rather "how do I know, in practice, if I should be concerned about dyslalia?" Some signs help to distinguish it:

If you notice several of these signs together, it increases the likelihood of it being dyslalia and not just "prolonged baby talk".

• Persistent sound substitutions after age 4

• Speech that is difficult to understand for people who do not interact with the child daily.

• Frequent omissions of consonants at the beginning, middle, or end of words.

• Distortions of sounds, such as a very breathy "s" or a strangely sounding "r".

• The child avoids speaking in public, responds little or only with gestures.

• Comments from educators or teachers regarding unclear speech.

• Visible frustration in the child when they have to repeat what they said.

When these signs persist over time, they begin to impact self-esteem, classroom participation, and how the child relates to others. It is precisely here that diagnosis and treatment make a huge difference.

Most frequent causes of dyslalia 

Dyslalia can result from several factors, which may act alone or in combination.

In general, the most commonly described causes in the literature include:

• Structural changes in the oral cavity

  • Altered palate, malformations, cleft palate, cleft lip

  • Dental malocclusion or significant changes in tooth position

• Changes in the frenulum of the tongue

  • The so-called "short frenulum" can limit tongue movements and promote dyslalia in certain sounds, especially those that require elevation or vibration of the tongue.

• Maladjusted orofacial function

  • Ineffective chewing patterns

  • Open-mouth posture and mouth breathing

  • Inappropriate tongue position at rest and during speech.

  • In these cases, dyslalia often appears associated with patterns such as mouth breathing, requiring collaborative work on speech and function.

• Hearing issues

  • Recurrent ear infections

  • Undetected mild hearing loss

  • If a child does not hear certain sounds clearly, they are more likely to develop dyslalia (discordant/alphabetic speech) related to those same sounds.

• Environmental and learning factors

  • Limited exposure to clear speech models.

  • Adults who retain "baby talk" for a long time“

  • The environment was not very stimulating in terms of conversations, stories, and reading.

• Associated conditions

  • Developmental disorders

  • Neurological conditions

  • Other communication disorders, in which dyslalia appears as part of a broader picture.

It is important to emphasize that dyslalia is not explained by "laziness," "quirks," or "lack of effort." It is a real difficulty in articulating sounds, which deserves to be understood and addressed.

Types of dyslalia

When studying dyslalia in a more technical way, it is common to find different classifications, which help guide diagnosis and treatment. The most common include:

• Evolutionary dyslalia

  • Typical developmental errors expected in young children.

  • They usually disappear without intervention as the child grows.

  • Dyslalia is only considered problematic if it persists beyond the expected age.

• Functional dyslalia or phonological disorder

  • There are no evident structural changes nor neurological damage.

  • The difficulty lies in learning and organizing the sounds.

  • It is one of the most frequent forms of dyslalia in preschool and school-age children.

• Audiogenic dyslalia

  • Dyslalia associated with hearing loss

  • This results from the child not hearing the sounds they are supposed to reproduce with sufficient precision.

• Organic dyslalia

  • Related to malformations, structural changes, or neurological lesions.

  • Common in children with cleft palate or other anatomical abnormalities.

Dyslalia and other communication disorders

It rarely exists in isolation. It commonly appears in conjunction with other difficulties, and this influences how dyslalia is approached in speech therapy.

Some children exhibit dyslalia simultaneously with Language delay, That is, they start speaking later, with simpler sentences and a smaller vocabulary. 

Dyslalia can also exist in children with childhood stuttering, in which the main difficulty lies in speech fluency, but there are also articulatory substitutions that need to be worked on.

During school age, it is relatively common to observe dyslalia in children with Dyslexia, a specific reading disorder in which phonological processing difficulties can affect both how a child reads and how they organize sounds in speech.

In more complex cases, dyslalia can coexist with apraxia of speech childhood, where the central problem lies in the motor planning of speech, or with more pronounced orofacial motor disorders.

In all these cases, discussing dyslalia is just one piece of a larger puzzle that needs to be carefully evaluated.

Assessment of dyslalia in speech therapy

When dyslalia is suspected, the next step is a detailed speech therapy assessment. This is where it is confirmed whether dyslalia is actually present, which sounds are affected, and what other aspects of communication are involved.

Typically, the process of evaluating dyslalia includes:

• Interview with the parents

  • History of child development

  • History of pregnancy, childbirth, health, ear infections, surgery

  • Languages present at home and at school.

• Observation of global communication

  • How the child interacts, asks for help, asks questions

  • If dyslalia is limiting the desire to speak

• Specific assessment of the joint

  • Naming images, repeating words and phrases.

  • Rigorous identification of the sounds in which dyslalia occurs, in initial, medial, and final word positions.

• Assessment of orofacial motor skills

  • Strength and coordination of lips, tongue, and jaw.

  • Chewing and swallowing pattern

  • Checking for signs of mouth breathing that may be contributing to dyslalia.

• When necessary, coordination with other professionals.

  • Pediatrician, otolaryngologist, or other specialists

  • Referral for hearing evaluation if hearing loss is suspected.

In the end, the speech therapist The person explains the dyslalia diagnosis to the family, presents a clear intervention plan, and sets realistic goals.

Today, this support can be provided through in-person speech therapy or, in many cases, through online speech therapy, which facilitates access when families have busy schedules or live far from major urban centers.

Treatment of dyslalia

When discussing dyslalia, causes and treatment always go hand in hand. Fortunately, dyslalia treatment, especially when started early, usually has a very favorable prognosis.

In general terms, the treatment of dyslalia in speech therapy follows several steps:

• Sound awareness

  • The child learns to listen attentively to the sound involved in the dyslalia.

  • Minimal pairs (e.g., "cat" vs. "touch") and auditory games are used to distinguish sounds.

• Isolated sound production

  • The therapist helps the child find the correct position of the tongue, lips, and jaw.

  • Use mirrors, visual and tactile cues

  • The goal is for the dyslalia to cease to exist, at least in that isolated sound.

• Production in syllables, words and sentences

  • The correct sound is integrated into syllables (“ga, gue, gui, go, gu”), then into words and phrases.

  • The dyslalia is gradually being replaced by a correct pattern, step by step.

• Generalization for spontaneous speech

  • Games, stories, and guided conversations help translate the benefits of therapy into everyday life.

  • The family is involved to reinforce the correction of dyslalia in a natural context.

• Orofacial motor skills training when necessary.

  • If the dyslalia is linked to muscle weakness or inadequate patterns, exercises for the tongue, lips, and cheeks are included.

  • In these cases, the work is often linked to aspects such as chew e breathing

The treatment time for dyslalia varies depending on the child's age, the number of sounds involved, and the presence or absence of other associated difficulties. But the rule is clear: the earlier dyslalia is addressed, the faster and more stable the progress tends to be.

The role of parents in the treatment of dyslalia.

No dyslalia treatment plan is complete without the active participation of the family. What is done at home, between sessions, is crucial for consolidating achievements and accelerating the overcoming of dyslalia.

Some simple and effective strategies include:

• Offer good speech models

  • Speak clearly, slowly and articulately.

  • Avoid imitating the mistakes of someone with a lisp "because it's funny"“

• Repeating without aggressively correcting

  • If the child says "cat," the adult can respond, "Yes, the cat is sleeping."“

  • The dyslalia is corrected implicitly, without direct criticism.

• Read every day

  • Stories with rhymes, repetition, and rhythm help to work on sounds affected by dyslalia.

  • Reading aloud reinforces vocabulary and phonological awareness.

• Playing with sounds

  • Rhyming games, tongue twisters, songs, and games like "what word starts with...?"“

  • These are playful ways to work on dyslalia without it feeling like "homework".“

• Give the child time to speak.

  • Don't always finish the sentences for her.

  • Listen attentively, show genuine interest, even when the speech impediment is still very pronounced.

• Strengthen the effort, not just the "success".“

  • Appreciate when the child tries to correct the speech impediment.

  • Focus on progress and not just on mistakes.

These strategies ensure that the treatment of dyslalia is no longer "something that only happens during consultations" but becomes an ongoing process, integrated into the family's routine.

When to seek help and why it's not worth waiting.

When faced with concerns about dyslalia, many parents hear phrases like "it's better to wait, each child has their own time." While it's true that each child has their own pace, it's also true that early intervention in dyslalia brings very clear benefits.

In practical terms, it is advisable to seek evaluation in speech therapy when:

• Speech remains unclear even after age 4.

• There are very frequent exchanges, omissions, or distortions.

• The child becomes frustrated or avoids speaking because of dyslalia.

• Educators or teachers report difficulties in perceiving it.

• There are other associated signs, such as Language delay, reading difficulties or stuttering children

Even if, in the end, it is concluded that the dyslalia is still within the expected range, it is always beneficial to have the issue clarified. And, if the dyslalia already justifies intervention, starting early means giving the child a huge advantage in their school and social development.

Conclusion

Having arrived here, we have already seen in detail what dyslalia is, what causes dyslalia, how dyslalia is evaluated, and what the general guidelines for dyslalia treatment are. The main message is simple: dyslalia is not laziness, it is not a lack of intelligence, and it is not a personality "defect." It is a specific difficulty in articulating speech sounds, which can and should be worked on.

When dyslalia is addressed through speech therapy, with the active participation of the family and, ideally, the collaboration of the school, the child gains clarity in speech, self-confidence, and greater pleasure in communicating. Instead of remaining silent out of shame about the dyslalia, they begin to want to tell stories, ask questions, and participate.

If you feel that your child's speech "is not keeping up" and you recognize several signs described throughout this article, don't wait for the dyslalia to go away on its own.

Seek support through speech therapy, also consider the flexibility of online speech therapy when necessary, and give the child the opportunity to be fully heard. Dyslalia is just one chapter; with the right help, this chapter can end with confident, clear communication full of possibilities.