Conducting a thorough oral mechanism exam (OME) should be a key component of any comprehensive speech evaluation. Identifying and/or ruling out underlying structural, functional, and motoric impairments is critical and necessary for the differential diagnosis of speech sound disorders because accurate differential diagnosis is key for the selection of appropriate interventions, which in turn provides for more effective and efficient outcomes. For example, if a child’s primary underlying speech deficit is motoric in nature, rather than phonological, an evidence-based intervention that incorporates principles of motor learning would be more suitable than phonological approaches. In addition, an OME can reveal red flags for dysarthria, which is present in around half of all children with cerebral palsy, prevalent among pediatric stroke and Down Syndrome, and occurs in 30% of children with pediatric neuromuscular diseases (Kooi-van Es et. al. 2020). Red flags for childhood apraxia of speech and myofunctional disorders may also be revealed, which can help clinicians target their assessments further. In addition, OMEs may also reveal underlying structural differences for which referrals to specialists may be appropriate. This presentation will specifically address what oral/facial structures and motor tasks can help SLPs differentially diagnose speech sound disorders and what findings may lead them to consider appropriate referrals to specialists. Videos of actual assessments will be shown to demonstrate particular aspects of an oral mechanism exam administration.