Speech Therapy Case Study of a 3-year-old girl with a developmental speech sound delay.

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By Sophie Sidney, Speech and Language Therapist.


Reasons for referral

Lilly was referred for speech therapy by her parents and school due to concerns over her difficulties pronouncing certain speech sounds. These difficulties were making it hard for others, especially those outside her family, to understand Lilly. Lilly had suffered from hearing loss and had grommets inserted at age 3.

As children develop their speech sounds they progress through a certain number of ‘speech processes’ which are essentially ‘normal error’. These resolve naturally by certain ages. However, for many reasons, including hearing loss, some children have delayed speech development and benefit from speech therapy to resolve this.



Lilly was seen for an initial assessment to look at her current speech profile and to provide information as to whether intervention was needed and what kind.  Assessment results revealed that Lilly had difficulties with the ‘t’ and ‘d’ sounds and was replacing these with ‘k’ and ‘g’ so ‘letter’ was ‘lekker’ and  ‘bed’ was ‘beg’. This process is called ‘backing’ whereby sounds that should be produced at the front of the mouth are produced at the back instead.  This is not a process found in typically developing speech and therefore was targeted in therapy.

Lilly also showed difficulties with other early developing sounds ‘s’ and ‘v’. These sounds that are produced with a long flow of air were being cut short so ‘f’ was ‘p’  -therefore  ‘fish’ was ‘pish.’ This process is called stopping which is expected to have resolved by the age of 3 years and so was also targeted in therapy.



Lilly was seen for individual therapy sessions. The sessions focused on developing Lilly’s awareness and production of the above speech sounds and processes.  For each sound visual materials were used to help Lilly learn them including a picture card with the grapheme and cued articulation (similar to a gesture/sign). Before asking Lilly to produce any of the sounds she had difficulties with, Lilly was provided with many opportunities to hear these sounds being produced correctly (this is known as auditory bombardment). Lilly then completed tasks in which she had to discriminate between a target sound e.g.  ‘t’ and the sound that she replaced it with e.g. ‘k’ to ensure she could tell the two apart.

Therapy then moved on to production. How each of the sounds is produced in the mouth was explained to Lilly using words accompanied by diagrams.  The first step was to get Lilly to have a go at producing her new sounds in isolation (e.g. ‘t’) and then combined with a vowel (e.g. ‘tee’). The next steps were to practice new sounds at the start of words (e.g. ‘tiger’), followed by the end of words (e.g.’boat’) and then in the middle of words (e.g. ‘bottle’) and finally onto sentences.  These were incorporated into fun games. Parents and school staff were given activities to practice in between weekly sessions and advise on how to support Lilly’s new speech sounds in natural conversations was also given, for example if Lilly made an error with one of her new speech sounds, others were to provide her with options e.g. is it a ‘kiger’ or a  ‘tiger,’ emphasizing the correct sound.



Lilly made fantastic progress with her target sounds and her parents were very pleased with the difference therapy made to her speech.