The speech disorder we aren’t paying attention to

Q: What congenital syndrome…

  • May be more than twice as prevalent as autism?

  • Is often misdiagnosed or not spotted at all?

  • Results in a speech impairment for 90% of affected children?


A: It’s fetal alcohol spectrum disorder (FASD). And while all of us probably learned the hallmark physical features and cognitive/behavioral consequences (Do you know how often “philtrum” comes up on Jeopardy? It’s a lot!), the particulars of the speech impairment haven’t been well studied. Traditionally it’s talked about as a speech delay, but clinical SLPs have found the situation to be more… complicated than that.

Speech delay, disorder, or both? It matters, since you’ll approach treatment differently. But some research is missing to connect the dots and guide our intervention. This study begins that work by analyzing the speech of a group of boys* with FASD and comparing it with another group of typically-developing children. The boys with FASD had:

  • Slightly lower overall intelligibility

  • More consonant errors and some differences in order of mastery (in Dutch, FYI)

  • Extra difficulties with nonword repetition

  • Difficulties with auditory discrimination

  • Difficulties with oral motor skills (especially tongue control), causing issues with specific consonants

  • Speech errors related to craniofacial anomalies (e.g., high palate → denasalization errors)

The takeaways for SLPs? Speech in this population seems to be both delayed and disordered. It may be that motor planning and processing deficits are causing many of the speech issues we see. Beyond that, specific characteristics, such as hearing loss, tongue control issues, high arched palates, and phonological impairments (all of which some, but not all children with FASD will have) have additional effects on speech. Clinicians need to evaluate these underlying differences and difficulties and use that to guide treatment. And remember: These kids need a lot of repetition and practice to learn and generalize skills.

Unfortunately, there are no easy solutions for this population. They need “long-term dedicated treatment that is tailored to the individual profile under the guidance of SLPs who are trained in working with these children.” 

*Why just boys? Evidently no families of girls with FASD were willing to participate. Interesting.  So... sex-related differences in the FASD population are still an open question.


Terband, H., Spruit, M., & Maassen, B. (2018). Speech Impairment in Boys With Fetal Alcohol Spectrum Disorders. American Journal of Speech-Language Pathology / American Speech-Language-Hearing Association, 27(4), 1405–1425.