Written by: Roselyn Mathew / Articulation / January 25, 2023 / 8 minutes read

Misarticulation is the inability to produce speech sounds in the right manner. The speech sounds are produced by placing the tongue, soft palate (roof of the back part of the mouth), jaw or lips in different positions. Generally, the misarticulation errors are substitution by a different sound, deleting the sound, adding an extra sound or having a sound distortion. Misarticulation in adults mainly consists of sound distortions but can also include additions, substitutions and deletions. Generally, the person who has misarticulation is aware about the issue and might also try to correct the sound errors.

The cause can be divided broadly into structural, neurological and functional. It has also been observed that the cause can also be a combination of any 2 or all 3 categories.

Structural causes

The cause is termed structural if a part of the body that aids in speech is having some sort of impairment or structural defects.  The different structural causes are:

• Cleft lip and/or palate

A cleft in lips and/or palate might lead to misarticulation of sounds produced due to improper tongue placement, inadequate movement of the soft palate, inadequate lip closure or due to a cleft, fistula or hole which leads to hypernasality and nasal emissions. 

• Macroglossia or large tongue

If the size of the tongue is much larger than the average tongue size, it could cause unclear enunciation as the tongue won’t be able to move easily and maintain a proper position while producing different sounds. 

• Ankyloglossia or tongue tie

It is a condition where the band or membrane that connects the bottom of the tongue and the floor of the mouth (frenulum) is thick and short, which affects the mobility of the tongue. It has been seen that the mobility of the tongue is not much affected if the frenulum is slightly shorter or thicker than average. Speech becomes unclear if the frenulum is much thicker and much shorter than the average thickness or length. 

• Tongue splitting or bifurcation

Split tongue or bifid tongue means that the tongue is spit into 2 from the tip to the centre of the tongue. It can be seen in certain types of conditions or syndromes like Goldenhar syndrome, Klippel-Feil syndrome and orofaciodigital syndrome. The split tongue is seen from birth in these conditions and can persist till adulthood if left untreated.

It is also seen that some people undergo tongue splitting as a form of body modification for cosmetic purposes. The tongue is intentionally cut from the centre till the tongue tip. 

Split tongue could lead to unclear enunciation and distortions in speech.

• Microglossia or underdeveloped tongue

It is a condition where the tongue does not grow to the adult size and is shorter and narrower than the average tongue size. It can also lead to distortions in speech. 

• Hearing impairment

Certain sounds like the /s/ and /sh/ sounds are difficult to be heard and a person might have sound substitutions or distortions as they are not able to get feedback by listening to their and others’ speech. Misarticulation is associated with hearing impairment only if the person has impaired hearing since birth or before they learn to speak and not in the later years.

• Missing tooth/teeth

Missing tooth may or may not cause a distortion in speech. Some studies have shown that missing front tooth causes lisp and other studies have shown that enunciation is not affected due to missing tooth. However, distortion of speech sounds can happen if many teeth are missing.

• Malalignment of jaw

 Having an overbite, underbite or a tilted jaw can cause misarticulation in speech that mainly consists of distortions.  

Neurological causes

It is due to any damage to the nerves that are in the structures that help in speaking or that connect the brain and the structures. The neurological causes are:

• Dysarthria

Dysarthria is a neurological condition where the body tone is not normal due to nerve damage or brain injury. Along with the body the tone of the lips, tongue, soft palate and the jaw becomes abnormal leading to slurring and distortions in speech.

• Apraxia of speech

Apraxia of speech is caused due to a brain injury or nerve damage. Here, common articulation errors are substitutions, additions and omissions of sounds. 

Functional causes

A person might have improper articulation without any underlying conditions. It is due to faulty learning.

The symptoms of misarticulation are:

• Sound substitutions (Eg. saying /w/ instead of /r/)

• Sound omissions/deletions (Eg. saying /tevision/ instead of /television/)

• Sound additions (Eg. saying culay instead of clay)  

• Sound distortions (Eg. Saying /s/ sound which sounds distorted or different)

The different treatment approaches are:

• Surgery

Sometimes surgery is required for certain conditions like split tongue, large tongue, cleft lip and/ or palate, tongue tie etc.

• Prosthesis 

A prosthesis is a device that can be helpful to restore, replace or assist in having a normal or near normal function of a structure. Dental implants, artificial teeth, palatal lifts, palatal obturators are examples of prosthesis which can improve speech enunciation.

• Speech therapy

Speech therapy is important in order to have a clear enunciation. Even after surgery and prosthesis, a person might still have unclear speech as they are used to incorrect enunciation since childhood and are not able adapt to the new changes for enunciating different sounds. Also, minor adjustments may have to be made that are different from the actual mouth position due to the type of modification done. Speech therapy will also be helpful if the speech error is due to faulty learning and also if it is possible to correct speech without the need for surgery or prosthesis if the impairment is mild. 

Clear articulation is important for good communication. Misarticulation in adults can happen due to different types of issues. The nature and type of misarticulation can also be different depending on the underlying cause. It is important to seek therapy from a trained speech language pathologist, who will be able to assess, provide guidance for other types of treatment, if required, and correct speech errors.

To speak with one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.