Reevaluating How We Classify Speech Sound Disorders: A Ground-Truthing Perspective

For decades, speech-language pathology has relied on categorical labels to classify speech sound disorders (SSDs): articulation disorder, phonological disorder, and childhood apraxia of speech. These categories have shaped how we assess, diagnose, research, and treat children with speech difficulties.

But what if these labels are not serving the children we work with?

Our newly published peer-reviewed paper, “Reevaluating the Classification of Pediatric Speech Sound Disorders: A Ground-Truthing Perspective,” challenges the traditional diagnostic framework and invites the field to reconsider how we define, study, and support children with SSDs.

This work is not about abandoning therapy approaches or clinical expertise—it is about evolving our lens to better reflect how speech is actually learned, controlled, and adapted.

The Problem With Categorical Labels

Traditional SSD classifications assume that children fit neatly into diagnostic “boxes.” In practice, clinicians know this is rarely the case.

Many children:

• Show characteristics that span multiple categories
• Shift profiles over time
• Present with overlapping motor, linguistic, sensory, and cognitive influences
• Respond differently to the same treatment approaches
  

Yet our current system often forces a single label—one that may oversimplify the child’s speech system and obscure the why behind their errors.

The result?

Inconsistent diagnoses, limited explanatory power, and treatment decisions that may not fully align with the child’s underlying needs.

What Does “Ground Truthing” Mean?

Ground truthing is a concept borrowed from engineering and data science. It refers to validating theoretical models against real-world data.

Applied to speech sound disorders, ground truthing asks:

• Do our diagnostic categories reflect what we actually observe in children’s speech motor systems?
• Do perceptual labels align with objective movement patterns?
• Are we classifying based on mechanisms—or appearances?
  

Our paper argues that many SSD classifications are phenomenological (based on what speech sounds like) rather than mechanistic (based on how speech is produced).

Speech Errors Are Adaptive, Not Random

One of the core messages of this paper is that children’s speech errors are adaptive.

Speech production is a complex motor skill that develops over time. When a child’s system is still learning how to coordinate the jaw, lips, tongue, airflow, and timing, the speech patterns we hear often reflect:

• Developmental constraints
• Motor control limitations
• Efficiency strategies
• Stability vs. flexibility trade-offs
  

These errors are not simply “wrong sounds”—they are windows into how the child’s motor system is organizing speech.

Understanding this distinction changes everything.

Moving From Categories to Dimensional Profiles

Rather than relying on rigid diagnostic categories, we propose a dimensional, profile-based framework for understanding SSDs.

This approach emphasizes:

• Gradients of motor control, stability, and coordination
• Individual variability rather than binary diagnoses
• Strengths and constraints across multiple domains
• How speech adapts under different task demands
  

In other words, we shift from asking “Which box does this child fit into?” to “What does this child’s speech system need to learn next?”

Why Objective Measures Matter

Perceptual transcription remains essential—but it is not sufficient on its own.

The paper highlights the growing role of instrumental and objective tools, such as:

• Ultrasound visual biofeedback
• Kinematic and movement-based analyses
• Acoustic and temporal measures
  

These tools allow clinicians and researchers to examine how speech movements are coordinated—not just how they sound. This aligns speech pathology with broader trends in healthcare toward precision medicine: tailoring intervention based on the individual system, not just the diagnosis.

What This Means for Clinical Practice

This framework does not eliminate phonological therapy, contrasts, or sound-based approaches. Instead, it expands them.

A ground-truthed, motor-informed perspective helps clinicians:

• Make sense of mixed or shifting profiles
• Individualize treatment targets and cueing strategies
• Adjust dose, frequency, and feedback more intentionally
• Explain progress (and plateaus) more clearly to families
  

Most importantly, it honors the complexity of the children we serve.

Looking Ahead 

This paper is not the final word—it is an invitation.

An invitation to:

• Reconsider long-held diagnosic categories
• Integrate motor learning science more deeply into SSD frameworks
• Use emerging technologies responsibly and accessibly
• Move toward a more precise, child-centered model of care
  

The future of speech-language pathology is not about replacing what works—it is about refining it.

Read the Full Paper

The full article is open access and available for download:

Click here!

Namasivayam, A. K., Kent, R., Preston J. L., Maassen, B. A. M., Hagedorn, C., Nip, I. S. B., McAllister, A., Wang, J., Hustad, K., Menard, L., Bahar, N., Moore, J., Petrosov, J., & van Lieshout, P. Reevaluating the classification of pediatric speech sound disorders: A ground truthing perspective. Frontiers in Human Neuroscience. doi 10.3389/fnhum.2025.1700505

If this work resonates with you, you are not alone. The field is evolving—and this conversation is just getting started.