A speech disorder is characterized as a person having difficulty producing speech sounds correctly or fluently, or having problems with their voice. Articulation disorders and stuttering are examples of speech disorders.
A language disorder can include receptive language and/or expressive language. A receptive language disorder refers to having trouble understanding others and an expressive language disorder refers to having difficulty expressing complete thoughts, ideas, and feelings. A person can have a language disorder affecting both their expressive and receptive language or they can have a language disorder in only one area.
Oral-motor problems can be divided into two categories, execution and praxis. Execution issues include weakness, decreased range of motion, decreased strength and decreased speed. There are non-verbal and verbal components to both categories. Verbal execution issues include dysarthria. Praxis refers to planning and programming movement. Verbal praxis issues include Childhood Apraxia of Speech. Nonverbal issues under the category of praxis include nonverbal oral apraxia.
Childhood Apraxia of Speech (CAS)
Childhood apraxia of speech is motor disorder of speech. Children with CAS have problems producing sounds, syllables, and words due to difficulties with motor planning (programming, planning, and producing speech movements). Motor planning consists of the ability of the brain to send the signals to the mouth in order to coordinate the oral movements needed to produce the intended words. The child often knows what he or she wants to say, but has difficulty planning and producing the refined movements of the jaw, lips, palate and tongue that is needed to produce clear speech. Apraxia of speech is at times called verbal apraxia or verbal dyspraxia. It is characterized by inconsistent sound production and difficulty coordinating oral movement and is a specific speech disorder. Evaluation by a speech and language pathologist experienced in diagnosing and treating CAS is essential to determine if your child has CAS and to rule out other causes of speech problems.
Signs or Symptoms of CAS:
The following is according to the American Speech-Language-Hearing Association (ASHA). Not all children will demonstrate all of the signs or symptoms that are listed below. It is difficult to diagnose CAS in children under three years old though the disorder may be suspected and intervention can be initiated. Often “diagnostic” therapy can help determine if the cause of difficulty with speaking is due to CAS.
In very young children:
- Does not babble or coo as an infant
- First words are late, and they may be missing sounds
- Only a few different consonant and vowel sounds
- Difficulties combining sounds; may show long pauses between sounds
- Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
- May have problems with feeding/eating
In older children:
- Makes inconsistent sound errors that are not the result of immaturity
- Can understand language much better than he or she can speak
- Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
- May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
- Has more difficulty saying longer words or phrases clearly than shorter ones
- Appears to have more difficulty when he or she is anxious
- Is hard to understand, especially for an unfamiliar listener
- Sounds choppy, monotonous, or stresses the wrong syllable or word
Dysarthria is a motor speech disorder that results from neuro-motor impairment to the muscles required to produce speech. Dysarthria is characterized by muscle fatigue and weakness, sound distortions, inaccurate sound production, decreased range of motion, muscle tone and speed of movement. It may be the result of brain damage due to: brain tumor, dementia, stroke or a traumatic brain injury. Dysarthria may result from damage to the nerves connected to the muscles that help you talk or from damage to the muscles themselves from: face or neck trauma or surgery for head and neck cancer. It may be the result of diseases that affect the nerves and muscles such as: Cerebral palsy, multiple sclerosis, muscular dystrophy, myasthenia gravis, and Parkinson’s disease.
Articulation or speech production is how clearly a speech sound is made. Articulation requires a motor action which leads to the sequential production of sounds. A child may have difficulty with one particular sound or with a group of sound classes. If the difficulty with multiple speech sounds show a pattern, this would be classified as a phonological disorder. Difficulties producing the correct sounds required for formation of words and fluid speech could result from dysarthria (oral motor weakness), oral-motor difficulties, apraxia (the coordination of speech sound movements) or processing differences. Difficulties with articulation can include sound omissions, substitutions, and distortions of speech sounds. There is a developmental trajectory for the ability to produce certain sounds. A screening/evaluation by a skilled speech and language pathologist will determine whether the sounds your child has difficulty with are developmentally appropriate or a cause for concern.
Disorders of Fluency or Stuttering
Fluency refers to the rhythm and fluidity of speech. Fluency disorders are characterized by repetitions (sounds or words), pauses, or drawn out syllables, words and phrases. In more severe cases groping or nonverbal symptoms such as ticks, may be present.
Voice disorders refer to an abnormality of one or more of the three characteristics of voice: pitch (intonation), intensity (loudness), and quality (resonance). Voice disorders may be caused by vocal strain (repeated yelling/whispering), vocal cord dysfunction, infection, inflammation, neuromuscular disorder, or psychological conditions.
Receptive language is the understanding/comprehension of language. It typically precedes the development of spoken or expressive language. It begins with the comprehension of sounds/words, concepts, and basic questions. Attention, sensory processing, engagement, auditory processing and hearing impairments can impact the development of receptive language comprehension.
Expressive language is the ability to express thoughts, ideas, and feelings through the use of gestures, spoken words, and written symbols. It includes the development of an ever-expanding vocabulary, the use of pronouns or tenses (morphology), correct grammar (syntax), language organization, and social language (pragmatics). Difficulties in any of these areas can impact the ability to communicate with others, learn in school, and socialize with peers.
Oral-Motor skills refer to the strength and muscle tone needed to perform a variety of verbal and nonverbal motor actions of the mouth. This includes activities such as blowing, using a straw, and chewing resistive foods. Oral motor development affects learning how to eat and produce sounds. Children who drool excessively, can’t drink from a straw, have difficulty chewing and are difficult to understand may have oral motor deficits. Therapy focusing on improving oral motor skills typically includes working on oral awareness, oral stretching, and oral exercises to improve strength and speed of mouth movements.
Pragmatic language refers to the use of language in a social context, including verbal and nonverbal communication. Initiating conversations with others, communicative turn taking, body language, attending to and responding to a communicative partner, maintaining appropriate distance from partner (personal space), and maintaining a conversational topic are all examples of pragmatic skills. Different cultures have their own pragmatic use of language including idioms, jokes, affect, and tone of voice.