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Speech disorders - children

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Speech disorders refer to several conditions in which a person has problems creating or forming the
speech sounds needed to communicate with others.
Three common speech disorders are:

Articulation disorders
Disfluency

Voice disorders

Speech disorders are different from language disorder in children, such as:

Getting their meaning or message across to others


Understanding the message coming from others

See: Language disorder - children


Causes
Speech is one of the main ways in which we communicate with those around us. It develops naturally,
along with other signs of normal growth and development.
Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the
most serious disfluency.
Articulation disorders may have no clear cause. They may also occur in other family members. Other
causes include:

Problems or changes in the structure or shape of the muscles and bones used to make speech

sounds. These changes may include cleft palate and tooth problems.
Damage to parts of the brain or the nerves (such as from cerebral palsy) that control how the
muscles work together to create speech.

See also: Phonological disorders


Voice disorders are caused by problems when air passes from the lungs, through the vocal cords, and
then through the throat, nose, mouth, and lips. A voice disorder may be due to:

Acid from the stomach moving upward


Cancer of the throat

Cleft palate or other problems with the palate

Conditions that damage the nerves that supply the muscles of the vocal cords

Laryngeal webs or clefts (a birth defect in which a thin layer of tissue is between the vocal cords)

Noncancerous growths (polyps, nodules, cysts, granulomas, papillomas, or ulcers) on the vocal
cords

Overuse of the vocal cords from screaming, constantly clearing the throat, or singing

Symptoms
Disfluency (stuttering is the most common type of disfluency):

Repetition of sounds, words, or parts of words or phrases after age 4 (I want...I want my doll. I...I

see you.)
Putting in (interjecting) extra sounds or words (We went to the...uh...store.)

Making words longer (I am Boooobbby Jones.)

Pausing during a sentence or words, often with the lips together

Tension in the voice or sounds

Frustration with attempts to communicate

Head jerking while talking

Eye blinking while talking

Embarrassment with speech

Articulation disorder:

Sounds may be distorted (changed)


Sounds (most often consonants) will be substituted, left off, added, or changed

Errors may make it hard for people to understand the person (only family members may be able
to understand a child)

See also: Phonological disorders


Voice disorders:

Hoarseness or raspiness to the voice


Voice may break in or out

Pitch of the voice may change suddenly

Voice may be too loud or too soft

May run out of air during a sentence

Speech may sound odd because too much air is escaping through the hose (hypernasality) or too
little air is coming out through the nose (hyponasality)

Exams and Tests


The following tests can help diagnose speech disorders:

Denver Articulation Screening Examination


Early Language Milestone Scale

Denver II

Peabody Picture Test Revised

A hearing test may also be done.


Treatment
Milder forms of speech disorders may disappear on their own.
Speech therapy may help with more severe symptoms or speech problems that do not improve.
In therapy, the child will learn how to create certain sounds.
Outlook (Prognosis)
The prognosis depends on the cause of the disorder. Usually, speech can be improved with speech
therapy. Prognosis improves with early intervention.
Possible Complications
Speech disorders may lead to psychosocial problems associated with ineffective communication.
When to Contact a Medical Professional
Call your health care provider if:

Your child's speech is not developing according to normal milestones


You think your child is in a high-risk group

Your child is showing signs of a speech disorder

Prevention
Intellectual disability and hearing loss make children more likely to develop speech disorders. At-risk
infants should be referred to an audiologist for an audiology exam. Audiological and speech therapy can
then be started, if necessary.
As young children begin to speak, some disfluency is common. Children lack a large vocabulary and have
difficulty expressing themselves. This results in broken speech. If you place excessive attention on the

disfluency, a stuttering pattern may develop. The best way to prevent stuttering, therefore, is to avoid
paying too much attention to the disfluency.
Alternative Names
Articulation deficiency; Voice disorders; Vocal disorders; Disfluency; Communication disorder - speech
disorder
References

Speech and Language Impairments


197

Listen
Help with Listen Feature
NICHCY Disability Fact Sheet 11 (FS11)
January 2011, Resources updated April 2013
Approximately 7 pages when printed.

PDF version
En espaol | In Spanish

Table of Contents

Day in the life of an SLP


Definition of SL impairments
Development of SL skills
Characteristics of SL
impairments
Causes
Incidence

Finding help
Educational considerations
Tips for teachers
Tips for parents
Resources of more info

A Day in the Life of an SLP


Christina is a speech-language pathologist. She works with children and adults who have impairments
in their speech, voice, or language skills. These impairments can take many forms, as her schedule
today shows.
First comes Robbie. Hes a cutie pie in the first grade and has recently been diagnosed with childhood
apraxia of speechor CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a
monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. Its
not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it
communicates to the muscles involved in producing speech. The muscles need to move in precise
ways for speech to be intelligible. And thats what she and Robbie are working on.
Next, Christina goes down the hall and meets with Pearl in her third grade classroom. While the other
students are reading in small groups, she works with Pearl one on one, using the same storybook.
Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearls speech to be slurred,
very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So
thats what Christina and Pearl work onstrengthening the muscles used to form sounds, words, and
sentences, and improving Pearls articulation.
One more student to see4th grader Mario, who has a stutter. Shes helping Mario learn to slow down
his speech and control his breathing as he talks. Christina already sees improvement in his fluency.
Tomorrow shell go to a different school, and meet with different students. But for today, her day is
Robbie, Pearl, and Mario.
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Definition

There are many kinds of speech and language disorders that can affect children. In this fact sheet,
well talk about four major areas in which these impairments occur. These are the areas of:
Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty
articulating certain sounds, such as l or r);
Fluency | speech impairments where a childs flow of speech is disrupted by sounds, syllables, and
words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate
inhalation, exhalation, or phonation patterns;
Voice | speech impairments where the childs voice has an abnormal quality to its pitch, resonance, or
loudness; and
Language | language impairments where the child has problems expressing needs, ideas, or
information, and/or in understanding what others say. (1)
These areas are reflected in how speech or language impairment is defined by the nations special
education law, the Individuals with Disabilities Education Act, given below. IDEA is the law that makes
early intervention services available to infants and toddlers with disabilities, and special education
available to school-aged children with disabilities.
Definition of Speech or Language Impairment under IDEA
The Individuals with Disabilities Education Act, or IDEA, defines the term speech or language
impairment as follows:
(11) Speech or language impairment means a communication disorder, such as stuttering, impaired
articulation, a language impairment, or a voice impairment, that adversely affects a childs educational
performance. [34 CFR 300.8(c)(11]
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Development of Speech and Language Skills in Childhood


Speech and language skills develop in childhood according to fairly well-defined milestones (see
below). Parents and other caregivers may become concerned if a childs language seems noticeably
behind (or different from) the language of same-aged peers. This may motivate parents to investigate
further and, eventually, to have the child evaluated by a professional.
______________________
More on the Milestones of Language Development

What are the milestones of typical speech-language development? What level of communication skill
does a typical 8-month-old baby have, or a 18-month-old, or a child whos just celebrated his or her
fourth birthday?
Youll find these expertly described in How Does Your Child Hear and Talk?, a series of resource pages
available online at the American Speech-Language-Hearing Association (ASHA):
http://www.asha.org/public/speech/development/chart.htm
______________________
Having the childs hearing checked is a critical first step. The child may not have a speech or language
impairment at all but, rather, a hearing impairment that is interfering with his or her development of
language.
Its important to realize that a language delay isnt the same thing as a speech or language
impairment. Language delay is a very common developmental problemin fact, the most common,
affecting 5-10% of children in preschool. (2) With language delay, childrens language is developing in
the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to
abnormal language development. (3) Distinguishing between the two is most reliably done by a
certified speech-language pathologist such as Christina, the SLP in our opening story.
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Characteristics of Speech or Language Impairments


The characteristics of speech or language impairments will vary depending upon the type of
impairment involved. There may also be a combination of several problems.
When a child has an articulation disorder, he or she has difficulty making certain sounds. These
sounds may be left off, added, changed, or distorted, which makes it hard for people to understand
the child.
Leaving out or changing certain sounds is common when young children are learning to talk, of
course. A good example of this is saying wabbit for rabbit. The incorrect articulation isnt
necessarily a cause for concern unless it continues past the age where children are expected to
produce such sounds correctly. (4) (ASHAs milestone resource pages, mentioned above, are useful
here.)
Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the
rhythmic and forward flow of speechusually, a stutter. As a result, the childs speech contains an
abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be
seen in the face, neck, shoulders, or fists. (5)

Voice is the sound thats produced when air from the lungs pushes through the voice box in the throat
(also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels
up through the spaces of the throat, nose, and mouth, and emerges as our voice.
A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. (6)
The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as
if they are stuffed up. People with voice problems often notice changes in pitch, loss of voice, loss of
endurance, and sometimes a sharp or dull pain associated with voice use. (7)
Language has to do with meanings, rather than sounds. (8) A language disorder refers to an
impaired ability to understand and/or use words in context. (9) A child may have an expressive
language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in
understanding what others are saying), or a mixed language disorder (which involves both).
Some characteristics of language disorders include:

improper use of words and their meanings,


inability to express ideas,
inappropriate grammatical patterns,
reduced vocabulary, and
inability to follow directions. (10)

Children may hear or see a word but not be able to understand its meaning. They may have trouble
getting others to understand what they are trying to communicate. These symptoms can easily be
mistaken for other disabilities such as autism or learning disabilities, so its very important to ensure
that the child receives a thorough evaluation by a certified speech-language pathologist.
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What Causes Speech and Language Disorders?


Some causes of speech and language disorders include hearing loss, neurological disorders, brain
injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate, and vocal
abuse or misuse. Frequently, however, the cause is unknown.
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Incidence
Of the 6.1 million children with disabilities who received special education under IDEA in public schools
in the 2005-2006 school year, more than 1.1 million were served under the category of speech or
language impairment. (11) This estimate does not include children who have speech/language
problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral

palsy. Because many disabilities do impact the individuals ability to communicate, the actual incidence
of children with speech-language impairment is undoubtedly much higher.
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Finding Help
Because all communication disorders carry the potential to isolate individuals from their social and
educational surroundings, it is essential to provide help and support as soon as a problem is identified.
While many speech and language patterns can be called baby talk and are part of childrens normal
development, they can become problems if they are not outgrown as expected.
Therefore, its important to take action if you suspect that your child has a speech or language
impairment (or other disability or delay). The next two sections in this fact sheet will tell you how to
find this help.
Help for Babies and Toddlers
Since we begin learning communication skills in infancy, its not surprising that parents are often the
first to noticeand worry aboutproblems or delays in their childs ability to communicate or
understand. Parents should know that there is a lot of help available to address concerns that their
young child may be delayed or impaired in developing communication skills. Of particular note is the
the early intervention system thats available in every state.
Early intervention is a system of services designed to help infants and toddlers with disabilities (until
their 3rd birthday) and their families. Its mandated by the IDEA. Through early intervention, parents
can have their young one evaluated free of charge, to identify developmental delays or
disabilities, including speech and language impairments.
If a child is found to have a delay or disability, staff work with the childs family to develop what is
known as an Individualized Family Services Plan, or IFSP. The IFSP will describe the childs unique
needs as well as the services he or she will receive to address those needs. The IFSP will also
emphasize the unique needs of the family, so that parents and other family members will know how to
support their young childs needs. Early intervention services may be provided on a sliding-fee basis,
meaning that the costs to the family will depend upon their income.
______________________
To access early intervention services in your area
Consult NICHCYs State Resource Sheet for your state, available online at:
http://www.nichcy.org/state-organization-search-by-state

There, youll find a listing for early intervention under the first section, State Agencies. The agency
listed will be able to put you in contact with the early intervention program in your community.
______________________
To learn more about early intervention, including how to write the IFSP, visit NICHCY
at: http://nichcy.org/babies/overview/
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Help for School-Aged Children


Just as IDEA requires that early intervention be made available to babies and toddlers with disabilities,
it requires that special education and related services be made available free of charge to every
eligible child with a disability, including preschoolers (ages 3-21). These services are specially
designed to address the childs individual needs associated with the disabilityin this case, a speech
or language impairment.
Many children are identified as having a speech or language impairment after they enter the public
school system. A teacher may notice difficulties in a childs speech or communication skills and refer
the child for evaluation. Parents may ask to have their child evaluated. This evaluation is provided free
by the public school system.
If the child is found to have a disability under IDEAsuch as a speech-language impairmentschool
staff will work with his or her parents to develop an Individualized Education Program, or IEP. The IEP
is similar to an IFSP. It describes the childs unique needs and the services that have been designed to
meet those needs. Special education and related services are provided at no cost to parents.
There is a lot to know about the special education process, much of which you can learn at NICHCY,
which offers a wide range of publications on the topic. Enter our special education information
at:http://www.nichcy.org/schoolage/
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Educational Considerations
Communication skills are at the heart of the education experience. Eligible students with speech or
language impairments will want to take advantage of special education and related services that are
available in public schools.
The types of supports and services provided can vary a great deal from student to student, just as
speech-language impairments do. Special education and related services are planned and
deliveredbased on each students individualized educational and developmental needs.

Most, if not all, students with a speech or language impairment will need speech-language
pathology services. This related service is defined by IDEA as follows:
(15) Speech-language pathology services includes
(i) Identification of children with speech or language impairments;
(ii) Diagnosis and appraisal of specific speech or language impairments;
(iii) Referral for medical or other professional attention necessary for the habilitation of speech or
language impairments;
(iv) Provision of speech and language services for the habilitation or prevention of communicative
impairments; and
(v) Counseling and guidance of parents, children, and teachers regarding speech and language
impairments. [34 CFR 300.34(c)(15)]
Thus, in addition to diagnosing the nature of a childs speech-language difficulties, speech-language
pathologists also provide:

individual therapy for the child;


consult with the childs teacher about the most effective ways to facilitate the childs
communication in the class setting; and

work closely with the family to develop goals and techniques for effective therapy in class and
at home.

Speech and/or language therapy may continue throughout a students school years either in the form
of direct therapy or on a consultant basis.
Assistive technology (AT) can also be very helpful to students, especially those whose physical
conditions make communication difficult. Each students IEP team will need to consider if the student
would benefit from AT such as an electronic communication system or other device. AT is often the key
that helps students engage in the give and take of shared thought, complete school work, and
demonstrate their learning.
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Tips for Teachers


Learn as much as you can about the students specific disability. Speech-language impairments differ
considerably from one another, so its important to know the specific impairment and how it affects the
students communication abilities.

Recognize that you can make an enormous difference in this students life! Find out what the
students strengths and interests are, and emphasize them. Create opportunities for success.
If you are not part of the students IEP team, ask for a copy of his or her IEP. The students
educational goals will be listed there, as well as the services and classroom accommodations he or she
is to receive.
Make sure that needed accommodations are provided for classwork, homework, and testing. These
will help the student learn successfully.
Consult with others (e.g., special educators, the SLP) who can help you identify strategies for
teaching and supporting this student, ways to adapt the curriculum, and how to address the students
IEP goals in your classroom.
Find out if your state or school district has materials or resources available to help educators
address the learning needs of children with speech or language impairments. Its amazing how many
do!
Communicate with the students parents. Regularly share information about how the student is
doing at school and at home.
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Tips for Parents


Learn the specifics of your childs speech or language impairment. The more you know, the more
you can help yourself and your child.
Be patient. Your child, like every child, has a whole lifetime to learn and grow.
Meet with the school and develop an IEP to address your childs needs. Be your childs advocate. You
know your son or daughter best, share what you know.
Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the
SLP, find out how to augment and enrich the therapy at home and in other environments. Also find out
what not to do!
Give your child chores. Chores build confidence and ability. Keep your childs age, attention span,
and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the
job is done. Demonstrate. Provide help when its needed. Praise a job (or part of a job) well done.
Listen to your child. Dont rush to fill gaps or make corrections. Conversely, dont force your child to
speak. Be aware of the other ways in which communication takes place between people.

Talk to other parents whose children have a similar speech or language impairment. Parents can
share practical advice and emotional support. Visit NICHCYs State Sheets and find a parent group
near you. Look in the Disability-Specific section, under speech-language. State Sheets are online
at: http://nichcy.org/state-organization-search-by-state
Keep in touch with your childs teachers. Offer support. Demonstrate any assistive technology your
child uses and provide any information teachers will need. Find out how you can augment your childs
school learning at home.
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Readings and Articles


We urge you to read the articles identified in the References section. Each provides detailed and
expert information on speech or language impairments. You may also be interes

Speech disorder
From Wikipedia, the free encyclopedia

Main article: Speech and language pathology


This article needs additional citations for verification. Please help improve
this article by adding citations to reliable sources. Unsourced material may be
challenged and removed. (February 2008)

Speech disorder
Classification and external resources

ICD-10

F98.5-F98.6, R47

ICD-9

307.0, 784.5

MeSH

D013064

Speech disorders or speech impediments are a type of communication disorder where


'normal' speech is disrupted. This can meanstuttering, lisps, etc. Someone who is unable to speak due to
a speech disorder is considered mute.[1]
Contents
[hide]

1 Classification

1.1 Types of disorder

2 Causes

3 Treatment

4 Social effects

5 Language disorders

6 See also

7 References

8 External links

Classification[edit]
Classifying speech into normal and disordered is more problematic than it first seems. By a strict
classification[citation needed], only 5% to 10% of the population has a completely normal manner of speaking
(with respect to all parameters) and healthy voice; all others suffer from one disorder or another.
There are three different levels of classification when determining the magnitude and type of a speech
disorder and the proper treatment or therapy: [2]
1. Sounds the patient can produce
1. Phonemic- can be produced easily; used meaningfully and contrastively
2. Phonetic- produced only upon request; not used consistently, meaningfully, or
contrastively; not used in connected speech
2. Stimulable sounds
1. Easily stimulable
2. Stimulable after demonstration and probing (i.e. with a tongue depressor)
3. Cannot produce the sound
1. Cannot be produced voluntarily
2. No production ever observed

Types of disorder[edit]

Apraxia of speech may result from stroke or progressive illness, and involves inconsistent
production of speech sounds and rearranging of sounds in a word ("potato" may become "topato" and
next "totapo"). Production of words becomes more difficult with effort, but common phrases may
sometimes be spoken spontaneously without effort.
Cluttering, a speech disorder that has similarities to stuttering.

Developmental verbal dyspraxia also known as childhood apraxia of speech.

Dysarthria is a weakness or paralysis of speech muscles caused by damage to the nerves and/or
brain. Dysarthria is often caused by strokes, parkinsons disease, ALS, head or neck injuries, surgical
accident, or cerebral palsy.

Dysprosody is the rarest neurological speech disorder. It is characterized by alterations in


intensity, in the timing of utterance segments, and in rhythm, cadence, and intonation of words. The
changes to the duration, the fundamental frequency, and the intensity of tonic and atonic syllables of
the sentences spoken, deprive an individual's particular speech of its characteristics. The cause of
dysprosody is usually associated with neurological pathologies such as brain vascular
accidents, cranioencephalic traumatisms, and brain tumors.[3]

Muteness is complete inability to speak

Speech sound disorders involve difficulty in producing specific speech sounds (most often certain
consonants, such as /s/ or /r/), and are subdivided into articulation disorders(also called phonetic
disorders) and phonemic disorders. Articulation disorders are characterized by difficulty learning to
produce sounds physically. Phonemic disorders are characterized by difficulty in learning the sound
distinctions of a language, so that one sound may be used in place of many. However, it is not
uncommon for a single person to have a mixed speech sound disorder with both phonemic and
phonetic components.

Stuttering affects approximately 1% of the adult population. [1]


Voice disorders are impairments, often physical, that involve the function of the larynx or vocal
resonance.

Causes[edit]
In many cases the cause is unknown. However, there are various known causes of speech impediments,
such as "hearing loss, neurological disorders, brain injury, intellectual disability, drug abuse, physical
impairments such as Cleft lip and palate, and vocal abuse or misuse."[4] Child abuse may also be a cause
in some cases.[5]

Treatment[edit]
The examples and perspective in this article may not represent a worldwide
view of the subject. Please improve this articleand discuss the issue on
the talk page. (December 2009)

Many of these types of disorders can be treated by speech therapy, but others require medical attention
by a doctor in phoniatrics. Other treatments include correction of organic conditions and psychotherapy.[6]
In the United States, school-age children with a speech disorder are often placed in special
education programs. Children who struggle to learn to talk often experience persistent communication
difficulties in addition to academic struggles. [7] More than 700,000 of the students served in the public
schools special education programs in the 2000-2001 school year were categorized as having a speech
or language impediment. This estimate does not include children who have speech and language
impairments secondary to other conditions such as deafness".[4] Many school districts provide the
students with speech therapy during school hours, although extended day and summer services may be
appropriate under certain circumstances.
Patients will be treated in teams, depending on the type of disorder they have. A team can include SLPs,
specialists, family doctors, teachers,and family members.

Social effects[edit]
Suffering from a speech disorder can have negative social effects, especially among young children.
Those with a speech disorder can be targets of bullying because of their disorder. The bullying can result
in decreased self-esteem. Later in life, bullying is experienced less by a general population, as people
become more understanding as they age.

Language disorders[edit]
Language disorders are usually considered distinct from speech disorders, even though they are often
used synonymously.
Speech disorders refer to problems in producing the sounds of speech or with the quality of voice, where
language disorders are usually an impairment of either understanding words or being able to use words
and does not have to do with speech production [8]

See also[edit]

British Stammering Association

Motor speech disorders

FOXP2

Speech and language path

KE family

Speech and language path

Language disorder

Speech and language ass

List of voice disorders

Speech perception

Manner of articulation

Speech repetition

References[edit]

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