Factors associated with speech severity in preschool children with phonological disorder: A cross-sectional study

Isabela dos Santos Nobre; Danilo Oliveira Teles; Kelly Silva; Patrícia Aparecida Zuanetti

doi:10.1590/1982-0216/20262864326

Artigos Originais

Factors associated with speech severity in preschool children with phonological disorder: A cross-sectional study

Fatores associados à gravidade da fala em crianças pré-escolares com transtorno fonológico: um estudo transversal

Isabela dos Santos Nobre; Danilo Oliveira Teles; Kelly Silva; Patrícia Aparecida Zuanetti

http://dx.doi.org/10.1590/1982-0216/20262864326 Revista CEFAC, vol.28, n6, e4326, 2026

PDF

SciELO

Downloads: 3

Abstract

Purpose: to analyze the variables associated with greater severity of phonological disorder in children.

Methods: a study based on a retrospective analysis of medical records from a public health service. The final sample consisted of 49 children aged 3 years to 6 years and 11 months diagnosed with phonological disorder. Speech severity was determined using the Percentage of Consonants Correct-Revised (PCC-R), obtained through imitation and naming tasks. Variables related to receptive language and clinical, gestational, and family history (e.g., prematurity, otitis, among others) were also analyzed. Statistical analysis included beta regression models (α = 0.05).

Results: boys predominated in the sample, and moderate phonological disorder was the most frequent severity category. The most frequent phonological processes not expected for age were liquid simplification, velar fronting, stopping of fricatives, and devoicing of plosives/fricatives. The number of active phonological processes was associated with speech severity. The other variables were not significant.

Conclusion: speech severity in phonological disorder is multifactorial, and the number of active phonological processes was the main clinical marker.

Keywords

Speech Sound Disorder; Speech Intelligibility; Risk Factors; Child Language; Comorbidity

Resumo

Objetivo: analisar as variáveis associadas à maior gravidade do transtorno fonológico em crianças.

Métodos: estudo baseado na análise retrospectiva de prontuários de um serviço público de saúde. A amostra final foi composta por 49 crianças entre três e seis anos e 11 meses com diagnóstico de transtorno fonológico. A gravidade da fala foi determinada pelo Percentual de Consoantes Corretas - Revisado (PCC-R), obtido por meio das provas de imitação e nomeação. Também foram analisadas variáveis relacionadas à linguagem receptiva e aos históricos clínico, gestacional e familiar (ex.: prematuridade, otites e outros). A análise estatística incluiu modelos de regressão beta (α = 0,05).

Resultados: observou-se predominância do sexo masculino e maior frequência de transtorno fonológico de grau moderado. Os processos fonológicos não esperados para a idade mais frequentes foram simplificação de líquidas, frontalização de velar, plosivação de fricativas e ensurdecimento de plosivas/fricativas. O número de processos fonológicos ativos apresentou associação com a gravidade da fala. Outras variáveis não foram significativas.

Conclusão: a gravidade da fala no transtorno fonológico apresenta caráter multifatorial, sendo o número de processos fonológicos ativos o principal marcador clínico.

Palavras-chave

Transtorno Fonológico; Inteligibilidade da Fala; Fatores de Risco; Linguagem infantil; Comorbidade

Referências

1. Marchesan IQ. Definição e tratamento das alterações de fala de origem fonética. In: Cézar AM, Maksud SS, editors. Fundamentos e práticas em fonoaudiologia. 2nd ed. Rio de Janeiro: Revinter; 2015. p. 73-100.

2. Shriberg LD, Strand EA, Fourakis M, Jakielski KJ, Hall SD, Karlsson HB et al. A diagnostic marker to discriminate childhood apraxia of speech from speech delay: I. Development and description of the pause marker. J Speech Lang Hear Res. 2017;60(4):S1096-S1117. https://doi.org/10.1044/2016_JSLHR-S-15-0296 PMID:28384779.

3. Bowen C. Classification of children's speech sound disorders. Speech Lang Ther. 2011.

4. Wren Y, Miller LL, Peters TJ, Emond A, Roulstone S. Prevalence and predictors of persistent speech sound disorder at eight years old. J Speech Lang Hear Res. 2016;59(4):647-73. https://doi.org/10.1044/2015_JSLHR-S-14-0282 PMID:27367606.

5. Peterson RL, Pennington BF, Shriberg LD, Boada R. What influences literacy outcome in children with speech sound disorder? J Speech Lang Hear Res. 2009;52(5):1175-88. https://doi.org/10.1044/1092-4388(2009/08-0024) PMID:19403946.

6. Lamprecht RR. Aquisição fonológica do português: perfil de desenvolvimento e subsídios para terapia. Porto Alegre: Artmed; 2004.

7. Wertzner HF, Pagan-Neves LO. Diagnóstico diferencial dos transtornos fonológicos. In: Tratado de linguagem: perspectivas contemporâneas. 2015. p. 183-90.

8. Wertzner HF, Papp ACCS, Galea DES. Provas de nomeação e imitação como instrumentos de diagnóstico do transtorno fonológico. Pro-Fono R. Atual. Cientif. 2006;18(3):303-12. https://doi.org/10.1590/S0104-56872006000300010

9. Wertzner HF, Pagan LO, Galea DES, Papp ACCS. Características fonológicas de crianças com transtorno fonológico com e sem histórico de otite média. Rev Soc Bras Fonoaudiol. 2007;12(1):41-7. https://doi.org/10.1590/S1516-80342007000100009

10. Martins AC, Nascimento D, Pinto S, Alves D, Wertzner HF, Castro A. Phonological characteristics of European and Brazilian Portuguese in children with speech sound disorders. Clin Linguist Phon. 2021;35(11):1076-90. https://doi.org/10.1080/02699206.2020.1866673

11. Barrozo TF, Silva LAF, Matas CG, Wertzner HF. Neural encoding of speech sounds in children with speech sound disorders. Rev. CEFAC. 2025;27(4):e0425. https://doi.org/10.1590/1982-0216/20252740425

12. Namasivayam AK, Li-Han LY, Moore JG, Wong W, Van Lieshout P. Articulatory basis of phonological error patterns in childhood speech sound disorders. Front Hum Neurosci. 2025;19:1635096. https://doi.org/10.3389/fnhum.2025.1635096 PMID:41143150.

13. Nakeva von Mentzer C. Audiometric profiles in children with speech sound disorder. Clin Linguist Phon. 2021;35(9):847-73. https://doi.org/10.1080/02699206.2020.1833369 PMID:33225761.

14. Conlon C, Zupan B, Pirie E, Gupta C. Impact of otitis media on speech production in children. J Commun Disord. 2025;113:106490. https://doi.org/10.1016/j.jcomdis.2024.106490 PMID:39823773.

15. Pagliarin KC, Brancalioni AR, Keske-Soares M, Souza APR. Relação entre gravidade do desvio fonológico e fatores familiares. Rev. CEFAC. 2011;13(3):414-27. https://doi.org/10.1590/S1516-18462010005000066

16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. 5th ed. Washington (DC): APA; 2022.

17. Hong SM, Sim HS, Ko EJ, Kim YT, Yim D, Ha S. Speech sound development in preterm children. J Speech Lang Hear Res. 2026;69(3):860-73. https://doi.org/10.1044/2025_JSLHR-25-00166 PMID:41637237.

18. Salvago P, Gorgone E, Giaimo S, Battaglia E, Dispenza F, Ferrara S et al. Association between age at first words and speech sound disorders. Int J Pediatr Otorhinolaryngol. 2019;126:109602. https://doi.org/10.1016/j.ijporl.2019.109602 PMID:31374388.

19. Torres F, Fuentes-López E, Fuente A, Sevilla F. Factors associated with severity of speech production problems. J Commun Disord. 2020;88:106054. https://doi.org/10.1016/j.jcomdis.2020.106054 PMID:33038695.

20. Walquist-Sørli L, Caglar-Ryeng Ø, Furnes B, Nergård-Nilssen T, Donolato E, Melby-Lervåg M. Speech sound difficulties as risk factors. J Speech Lang Hear Res. 2025;68(1):164-77. https://doi.org/10.1044/2024_JSLHR-24-00170 PMID:39626051.

21. Wertzner HF, Pulga MJ, Pagan-Neves LO. Metaphonological skills in children with speech sound disorder. Audiol., Commun. Res. 2014;19(3):243-51. https://doi.org/10.1590/S2317-64312014000300007

22. Guedes-Granzotti RB, Felippini ACC, Zuanetti PA, Silva K, Domenis DR, Mandra PP et al. Working memory in children with phonetic and phonological deviation. Biosci J. 2017;33(3):763-8. https://doi.org/10.14393/BJ-v33n3-36470

23. Athayde ML, Carvalho Q, Mota HB. Vocabulário expressivo em crianças com desvio fonológico. Rev. CEFAC. 2009;11(Suppl 2):161-8. https://doi.org/10.1590/S1516-18462009000600005

24. Garrett AJ, Tukel S, Morgan AT. Long-term speech outcomes in speech sound disorder. Int J Lang Commun Disord. 2026;61(3):e70231. https://doi.org/10.1111/1460-6984.70231 PMID:41937368.

25. To CKS, McLeod S, Sam KL, Law T. Predicting normalization in speech sound disorders. J Speech Lang Hear Res. 2022;65(5):1724-41. https://doi.org/10.1044/2022_JSLHR-21-00444 PMID:35381182.

26. Foster ME, Choo AL, Smith SA. Speech-language disorder severity and outcomes. Front Psychol. 2023;14:1096145. https://doi.org/10.3389/fpsyg.2023.1096145 PMID:36891210.

27. Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. PCC metric. J Speech Lang Hear Res. 1997;40(4):708-22. https://doi.org/10.1044/jslhr.4004.708 PMID:9263938.

28. Menezes MLN. ADL 2: Avaliação do desenvolvimento da linguagem. 2nd ed. Rio de Janeiro: [publisher not stated]; 2019.

29. Wertzner HF. Fonologia. In: Andrade CRF, Bèfi-Lopes DM, Fernandes FDM, Wertzner HF, editors. ABFW. 3rd ed. Barueri: Pró-Fono; 2023.

30. Grigorova E, Ristovska G, Jordanova NP. Prevalence of phonological disorders. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2020;41(3):31-7. https://doi.org/10.2478/prilozi-2020-0043 PMID:33500374.

31. Carlino FC, Prette AD, Abramides DVM. Avaliação do grau de inteligibilidade de fala de crianças com desvio fonológico: implicações nas habilidades sociais. Rev. CEFAC. 2011;15(1):10-6. https://doi.org/10.1590/S1516-18462011005000106

32. Wertzner HF, Herrero SF, Ideriha PN, Pires SCF. Classificação do distúrbio fonológico. Pro-Fono R. Atual. Cientif. 2001;13(1):90-7.

33. Rosado IM, Donicht G, Simoni SN, Pagliarin KC, Keske-Soares M. Intelligibility perception. Rev. CEFAC. 2017;19(2):233-41. https://doi.org/10.1590/1982-0216201719215916

34. Patah LK, Takiuchi N. Prevalência de alterações fonológicas. Rev. CEFAC. 2008;10(2):158-67. https://doi.org/10.1590/S1516-18462008000200004

35. Macrae T, Tyler AA. Speech abilities in preschool children. Lang Speech Hear Serv Sch. 2014;45(4):302-13. https://doi.org/10.1044/2014_LSHSS-13-0081 PMID:25091539.

36. McNeill B, McIlraith AL, Macrae T, Gath M, Gillon G. Predictors of speech severity. J Speech Lang Hear Res. 2022;65(7):2459-73. https://doi.org/10.1044/2022_JSLHR-21-00611 PMID:35658466.

37. Ahmed M, Zaman S, Uppal AD, Riaz N, Sattar A, Rehman AU. Impact of otitis media on speech and language. Pak J Med Health Sci. 2024;18(1):602-5. https://doi.org/10.53350/pjmhs02024181602

38. Farquharson K, Tambyraja SR, Justice LM. Speech production accuracy. Lang Speech Hear Serv Sch. 2020;51(2):457-68. https://doi.org/10.1044/2019_LSHSS-19-00079 PMID:32160111.

Submetido em:
11/05/2026

Revisado em:
06/07/2026

Aceito em:
31/08/2026

Factors associated with speech severity in preschool children with phonological disorder: A cross-sectional study

Fatores associados à gravidade da fala em crianças pré-escolares com transtorno fonológico: um estudo transversal

Isabela dos Santos Nobre; Danilo Oliveira Teles; Kelly Silva; Patrícia Aparecida Zuanetti

Abstract

Keywords

Resumo

Palavras-chave

Referências

Links

Compartilhar

Revista CEFAC