associated with specific learning disorders.
Differential Diagnosis
Normal variations in speech. Regional, social, or cultural/ethnic variations of speech
should be considered before making the diagnosis.
Hearing or other sensory impairment. Hearing impairment or deafness may result in
abnormalities of speech. Defici ts of speech sound production may be associated with a
hearing impairment, other sensory deficit, or a speech-mo tor deficit. When speech deficits
are in excess of those usually associated with these problems, a diagnosis of speech sound
disorder may be made.
Structural deficits. Speech impairment may be due to stru ctural deficits (e.g., cleft palate).
Dysarthria. Speech impairment may be attributable to a motor disorder, such as cerebral
palsy. Neurological signs, as well as distinct ive features of voice, differentiate dysarthria
from speech sound disorder, although in young children (under 3 years) differentiation
may be difficult, particularly  when there is no or minima l general body motor involve-
ment (as in, e.g., Worster-Drought syndrome).
Selective mutism. Limited use of speech may be a sign  of selective mutism, an anxiety
disorder that is characterized by a lack of sp eech in one or more contexts or settings. Se-
lective mutism may develop in children with a speech disorder because of embarassment
about their impairments, but many children with selective mutism exhibit normal speech
in “safe” settings, such as at home or with close friends. 
Childhood-Onset Fluency Disorder (Stuttering)
Diagnostic Criteria 315.35 (F80.81)
A. Disturbances in the normal fluency and time patterning of speech that are inappropri-
ate for the individual’s age and language skills, persist over time, and are characterized