{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:29:48Z","timestamp":1789046988694,"version":"build-2803163510"},"reference-count":58,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang & Comm Disor"],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Historically, assessment of child speech has focused on transcription and analysis of speech sound production with no exploration of the child's own perception of his or her speech. This article explores the possibility that whilst children with speech \u2018difficulties\u2019 may be aware that \u2018talking to people\u2019 is problematic, they may\n not<\/jats:italic>\n be aware that the reason for their communication difficulty is that their speech is unclear. Similarly, in a therapy context, the child's own appreciation of the purpose and progress of therapy has not been explored. Given the current concern for child well\u2010being, particularly in educational settings, it is timely to examine the premise that all children with speech difficulties are\n consciously aware<\/jats:italic>\n that their speech is different, that they want to change the way they talk\n and<\/jats:italic>\n that they welcome help to improve their speech.\n <\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n This overview of a child's own perception of his or her \u2018disordered\u2019 speech aims to bring the child's perspective clearly into focus. Long\u2010held assumptions that children are aware of their speech differences and seek to change them are revisited, and consideration is given to the possibility that young children with speech disorders don't perceive the difference between adult pronunciations and their own. An ethical perspective of engaging young children in activities to change the way they talk before they have developed an appreciation that their pronunciation is different from an adult model is presented and considered. Readers will gain new insights into a child's perspective of not being understood and of being confused by efforts to help them to speak more clearly when their own perception is that their speech already matches the adult pronunciation. Clinicians will come to appreciate that strategies to \u2018help\u2019 children with their speech may feel confusing and even distressing to the child. Given the likelihood that children with SSD\/D have little or no awareness of their mispronunciations, a case is made for a less corrective, directive style of therapy and for more facilitative, non\u2010corrective therapy.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n Childhood experiences of growing up with speech sound difficulties are considered through child\u2010focused interpretation of clinical video data and relevant literature. Review of a small selection of parent\u2010consented videos originally collected for clinical or audit purposes prompted reflection on the child's perspective of assessment and therapy. In addition, adult reflections on their childhood experiences of speech problems in different contexts and at different ages were considered. Principles of ethical practice provided a framework for conceptualising ways in which well\u2010intentioned therapy might provoke imperceptible emotional harm. Strategies are proposed for ensuring that \u2018problem\u2010based\u2019 therapy is child\u2010focussed, promotes autonomy and positive self\u2010esteem and minimises the risk of imperceptible emotional harm.<\/jats:p>\n <\/jats:sec>\n \n Main Contribution<\/jats:title>\n This discussion article highlights a gap in clinicians\u2019 recognition that children in early and middle childhood (2\u20107\u00a0years) may be unaware of their specific speech differences and that they are likely to be confused by therapy activities that require them to change the way they talk. An ethical perspective introduces the possibility that, without some child\u2010focused explanation about the reason for therapy, intervention might cause distress, which children are likely to suppress, and, in some cases, long\u2010term therapy may cause emotional harm. Strategies based on ethical principles are proposed for communicating with children about speech and for introducing \u2018new ways\u2019 to pronounce sounds. Development of a training route for equipping speech and language therapists (SLTs) to adopt a non\u2010directive, collaborative style is recommended.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n From an ethical perspective, this discussion paper introduces the possibility that well\u2010intentioned therapy aimed at changing a child's speech could inadvertently cause emotional harm. It proposes that subtle adjustments to therapy style may elicit new sounds without conscious effort from the child, thereby reducing risks to emotional well\u2010being such as fear of failure and confusion when new productions are deemed to be \u2018right\u2019 but\n feel<\/jats:italic>\n wrong to the child. Collaboration between SLT, parents, school and, where possible, ELSA (Emotional Literacy Support Assistant) would reduce the risk of unintended harm that might be caused by practice\u2010based therapy.\n <\/jats:p>\n <\/jats:sec>\n \n WHAT THIS PAPER ADDS<\/jats:title>\n \n What is already known on this subject<\/jats:italic>\n \n \n The question as to whether or not children are able to perceive mismatches between their own mispronunciations and their intended production has, to date, been sadly overlooked. This is reflected in the absence of any reference to the child's perspective in routine speech assessments. Existing literature indicates that children have little or no awareness that their speech is distinctive or in what ways it needs to be changed. Hence, it is quite possible that a proportion of children undergoing therapy are confused and could be distressed by therapy which seeks to change the way they talk.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n What this study adds to existing knowledge<\/jats:italic>\n \n \n By viewing therapy to change and \u2018improve\u2019 a child's speech, from the child's perspective, this article invites clinicians to question their assumptions that children will appreciate \u2018help\u2019 to speak more clearly. Attention is drawn to the risk that therapy might provoke an accumulation of unexpressed negative emotions which could lead to emotional harm. Strategies are suggested for exploring a child's perspective of their speech and for creating opportunities for collaborative therapy planning in the hope that therapy might boost, rather than erode, a child's self\u2010esteem.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n What are the potential or actual clinical implications of this work?<\/jats:italic>\n \n \n Increased awareness of the risk that children who are compliant with therapy for speech \u2018differences\u2019 may experience emotions such as confusion, anger or general distress during therapy might lead to adjustments in therapy style. It is proposed that shared exploration of a child's speech patterns, with the child, at assessment, followed by collaborative therapy planning and child\u2010focussed progress reviews, might enrich both therapist and child experiences of therapy for speech differences in childhood.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.70255","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:42:17Z","timestamp":1779943337000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u2018Don't say \u201cfis\u201d say \u201cfish\u201d \u2019, \u2018I\n said<\/i>\n \u201cfis\u201d\u2019: Ethical Considerations in Therapy to Change Child Speech"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4194-859X","authenticated-orcid":false,"given":"Anne","family":"Harding\u2010Bell","sequence":"first","affiliation":[{"name":"Department of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery University of Sheffield, 362 Mushroom Lane, Sheffield, S10 8TS UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5814-9008","authenticated-orcid":false,"given":"Julie","family":"Davies","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University, Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0474-0626","authenticated-orcid":false,"given":"Lucy","family":"McAndrew","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust, Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_14_2_1","first-page":"3","volume-title":"Principles of Health Care Ethics","author":"Beauchamp T. 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