Speech Disorders

speech disorders

Speech refers to how a person produces speech sounds.
A speech disorder refers to problems producing correct speech sounds.

physiology

Physiology refers to the physical structures within the mouth - teeth, tongue, lips, etc.

In some cases, the physical structures of the mouth cause difficulty producing speech sounds.

Tongue Tie
Lip Tie
Oral Cavity Too Small
Tongue Too Large
Dentition
- Cross Bite
- Over Bite
- Under Bite
Muscle Weakness
Muscle Tightness

In some cases, limited intelligibility can be caused by hearing loss.
- It is important to get a child's hearing checked to rule out hearing loss induced speech delays.

Attention

Attention refers to a child's ability to focus and maintain focus.

In some cases, attention disorders can lead to decreased intelligibility.
- Learning to talk requires attention.
- Children must attend to the speech and language of other people to learn proper articulation.
- Children with attention disorders often have trouble attending to detail and miss important articulatory features when listening to the speech of others.

articulation

Articulation refers to the formation of correct and clear speech sounds.

Articulation Disorders occur when a child incorrectly produces specific speech sounds.

Errors are consistent. The child always substitutes the same error sound.
Errors are on specific speech sounds not entire groups or classes of sounds.
Errors are not attributed to another disorder or physical issue.
Errors are not developmentally appropriate. Some errors are expected at certain ages. If the errors persist past that age, an articulation disorder may be present. Click here to see what errors are considered developmentally appropriate.

phonology

Phonology refers to patterns within speech sounds. Speech sounds can be grouped based on where and how they are produced in the mouth.

Phonological disorders occur when a child uses phonological processes past the age of discontinuation.
- A phonological process is an age-appropriate, culturally consistent error pattern children use to learn to speak.
- Children's language (i.e., vocabulary and grammar) develop faster than their speech (i.e., ability to use proper speech sounds).
- Children use phonological processes to make words easier to pronounce. These phonological processes are consistent across cultures, allowing adults to understand "baby talk".
- Phonological processes have an age of discontinuation or an age where they should disappear.
- If these phonological processes persist past that age, a phonological disorder may be present. Click here to learn when specific phonological processes should disappear.

fluency

Fluency refers to the smoothness and flow of a person's speech.

A fluency disorder occurs when there are disruptions to a person's speech.
- Stuttering
- Cluttering
- Developmentally Appropriate Disfluency
  - Many children go through a developmentally appropriate period of stuttering.
  - It usually occurs between the ages of 2-5.
  - There is no family history of prolonged stuttering.
  - There is no tension or struggle when speaking.
  - Errors are primarily phrase repetitions, whole word repetitions, or interjections.
  - Stuttering lasts 6 months or less.

voice

Voice refers to the volume, quality, and pitch of a person's voice.

A voice disorder occurs when there is a problem with the quality, volume, or pitch of a person's voice.
A voice disorder can be:
- Functional
  - No physical problems with vocal structures but a person has difficulty using the structures properly.
    - Vocal fatigue - weakness or strain in the voice
      - Often caused by over-use or improper use of the vocal mechanism
      - Symptoms include:
        Decreased vocal range
        Pain in the throat
        Feeling of lump in the throat
        Frequent throat clearing
        Loss of voice
        Hoarseness
    - Muscle Tension Dysphonia - vocal changes due to increased muscle tension
      - Often caused by exerting too much strain or pressure on the vocal mechanism
      - Symptoms include:
        Rough, hoarse, raspy, gravelly voice
        Weak or breathy voice
        Voice that 'gives out'
        Tightness in the throat
        Pain in the throat
        Vocal strain
    - Diplophonia - The production of two sounds at the same time
      - Often caused by inflammation, trauma, degenerative disorders, infection, intubation
      - Symptoms include:
        Two different sounds produced at the same time
        Breathy voice
        Hoarseness
        Strangled sounding voice
        Increased pitch (i.e., shrill voice)
- Organic
  - Physical problems with the vocal structures
    - Vocal Fold Edema - swelling in or around the vocal folds
      - Often caused by smoking
      - Symptoms include:
        Low, raspy voice
        Shortness of breath
        Stridor
    - Vocal Fold Lesions - non-cancerous growths on the vocal folds including nodes, nodules, and polyps
      - Often caused by vocal overuse, improper use of the vocal mechanism, vocal strain
      - Symptoms include:
        Hoarseness
        Breathy voice
        Vocal fatigue
        Vocal loss
        Reduced vocal range
        Breaks in voice
        Frequent throat clearing or coughing
        Neck Pain
        Shooting pain from ear to ear
    - Ventricular Phonation - Vocal changes due to the compression of the true vocal folds by the ventricular folds (i.e., false vocal folds)
      - Often caused because true vocal folds are too stiff to vibrate and ventricular folds compensate becoming the source of vibration
      - Symptoms include:
        Low pitch
        Rough or scratchy voice
        Vocal strain
        Dysphonia (i.e., abnormal sounding voice)
    - Structural Changes - changes in vocal structures
      - Often caused by typical aging or medical treatments
      - Symptoms include:
        Reduced volume
        Pitch changes
        Vocal tremor or shakiness
        Vocal weakness
        Reduced vocal stamina
- Psychogenic
  - Vocal problems related to a psychological disorder, stress, or trauma.
    - Vocal Tremor - periodic, rhythmic, and frequent change in pitch or volume
      - Often caused by neurological issues, but specific causes are unknown
      - Symptoms include:
        Rhythmic changes in volume or pitch
        Quavering voice
    - Spasmodic Dysphonia - difficulty speaking due to spasms in the vocal mechanism
      - Often caused by abnormal brain functioning, specifically in the basall ganglia
      - Symptoms include:
        Difficulty producing sounds
        Specific symptoms depend on whether spasms cause the vocal folds to abruptly open or close
    - Vocal Fold Paralysis - difficulty speaking due to lack of movement in the vocal folds
      - Often caused by autoimmune diseases, infections, injury, neurological diseases, tumors, surgery or toxins
      - Symptoms include:
        Hoarseness
        Vocal weakness
        Pitch changes
        Volume changes
        Shortness of breath
        Trouble swallowing
        Choking

neurology

Neurology refers to the functioning of the brain and communication of the brain with other parts of the body.

A neurological impairment can affect a person's ability to speak as well as the quality of their speech.
- Dysarthria - a neurological impairment that causes muscle weakness in muscles related to speech
  - Often caused by brain injury, brain tumors, cerebral palsy, Huntington's disease, multiple sclerosis, muscular dystrophy, Parkinson's disease, stroke, medication
  - Symptoms include:
    - Slurred speech
    - Reduced speech rate
    - Vocal strain
    - Nasal voice
    - Decreased speech volume
    - Changes in rhythm and prosody
    - Difficulty moving muscles related to speech
- Apraxia - a neurological impairment that causes difficulty planning and sequencing motor movements
  - In adults, often caused by traumatic brain injury and stroke. In children, can be caused by brain injury or other neurological events, but often no cause can be identified.
  - Symptoms include:
    - Difficulty planning motor movements
    - Significantly decreased intelligbility
    - Groping for sounds
    - Errors patterns are inconsistent
    - Errors increase with increase in syllable length
    - In children - limited use of vowels and consonants
    - In children - limited use of babbling as infants

Beyond Words Speech and Language Therapy, LLC