Speech refers to how a person produces speech sounds.
A speech disorder refers to problems producing correct speech sounds.
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.
Oral Cavity Too Small
Tongue Too Large
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 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 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 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 refers to the smoothness and flow of a person's speech.
A fluency disorder occurs when there are disruptions to a person's speech.
Repetitions can include entire words, phrases, or just parts of words.
I I I want to go to the baseball game.
I w-w-w-ant to go to the baseball game.
I want to go to the base-base-base-baseball game.
I want I want I want to go to the baseball game.
Prolongations occur when a sound is held onto or spoken longer than normal.
W----------What do you want?
Interjections occur when a word or sound is inserted into normal speech.
How um is your um day?
Uh Uh Uh How Uh Uh Uh is Uh Uh Uh your day?
Blocks occur when a person becomes 'stuck' and no sound comes out.
Cluttering often sounds like rapid, disorganized speech. There will often be:
Word or phrase repetitions
Rapid speech rate
Slurred sounding speech
Interjections such as um or uh
Word collapse (i.e., puter for computer)
Unfinished words (i.e., refridge for refrigerator).
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 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:
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
Decreased vocal range
Pain in the throat
Feeling of lump in the throat
Frequent throat clearing
Loss of voice
Muscle Tension Dysphonia - vocal changes due to increased muscle tension
Often caused by exerting too much strain or pressure on the vocal mechanism
Rough, hoarse, raspy, gravelly voice
Weak or breathy voice
Voice that 'gives out'
Tightness in the throat
Pain in the throat
Diplophonia - The production of two sounds at the same time
Often caused by inflammation, trauma, degenerative disorders, infection, intubation
Two different sounds produced at the same time
Strangled sounding voice
Increased pitch (i.e., shrill voice)
Physical problems with the vocal structures
Vocal Fold Edema - swelling in or around the vocal folds
Often caused by smoking
Low, raspy voice
Shortness of breath
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
Reduced vocal range
Breaks in voice
Frequent throat clearing or coughing
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
Rough or scratchy voice
Dysphonia (i.e., abnormal sounding voice)
Structural Changes - changes in vocal structures
Often caused by typical aging or medical treatments
Vocal tremor or shakiness
Reduced vocal stamina
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
Rhythmic changes in volume or pitch
Spasmodic Dysphonia - difficulty speaking due to spasms in the vocal mechanism
Often caused by abnormal brain functioning, specifically in the basall ganglia
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
Shortness of breath
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
Reduced speech rate
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.
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